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1.
Obesity (Silver Spring) ; 28(7): 1171-1172, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32374528

RESUMO

Obesity treatment is highly stigmatized, mainly because of the stigma of obesity itself. The frequent withdrawal of medications, lorcaserin being the last example, contributes to this stigma, but it is also probably a reflection of it, as data suggest that the threshold for a withdrawal is lower than with other classes of drugs. Safety should always be an absolute priority for every new medication, especially when used on a chronic basis; however, the safety scrutiny given to antiobesity medications is not given for other medications, such as postmenopausal hormone therapy and central nervous system drugs for psychiatric use. The withdrawal of medications for obesity can also impact future research in the area, so we need transparency and equality. Transparency in knowing exactly what reason led to a drug being discontinued and equality in long-term safety should be a concern with any medication prescribed for chronic diseases.

2.
Diabetes ; 68(5): 947-952, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30765337

RESUMO

Melatonin, a pineal hormone synthesized at night, is critical for the synchronization of circadian and seasonal rhythms, being a key regulator of energy metabolism in many animal species. Although studies in humans are lacking, several reports, mainly on hibernating animals, demonstrated that melatonin supplementation and a short photoperiod increase brown adipose tissue (BAT) mass. The present proof-of-concept study is the first, to our knowledge, to evaluate BAT in patients with melatonin deficiency (radiotherapy or surgical removal of pineal gland) before and after daily melatonin (3 mg) replacement for 3 months. All four studied patients presented increased BAT volume and activity measured by positron emission tomography-MRI. We also found an improvement in total cholesterol and triglyceride blood levels without significant effects on body weight, liver fat, and HDL and LDL levels. Albeit not statistically significant, fasting insulin levels and HOMA of insulin resistance decreased in all four patients. The present results show that oral melatonin replacement increases BAT volume and activity and improves blood lipid levels in patients with melatonin deficiency, suggesting that melatonin is a possible BAT activator. Future studies are warranted because hypomelatoninemia is usually present in aging and appears as a result of light-at-night exposure and/or the use of ß-blocker drugs.


Assuntos
Tecido Adiposo Marrom/efeitos dos fármacos , Tecido Adiposo Marrom/metabolismo , Melatonina/farmacologia , Peso Corporal/efeitos dos fármacos , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Metabolismo Energético/efeitos dos fármacos , Feminino , Humanos , Masculino , Triglicerídeos/sangue
3.
Int J Obes (Lond) ; 42(5): 953-963, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29777228

RESUMO

BACKGROUND: Obesity causes secondary hypogonadism (HG) in men. Standard testosterone (T) replacement therapy improves metabolic parameters but leads to infertility. OBJECTIVE: To evaluate clomiphene citrate (CC) treatment of adult men with male obesity-associated secondary hypogonadism (MOSH). DESIGN: Single-center, randomized, double-blind, placebo-controlled trial. PARTICIPANTS: Seventy-eight men aged 36.5 ± 7.8 years with a body mass index (BMI) > 30 kg/m2, total testosterone (TT) ≤ 300 ng/dL, and symptoms in the ADAM questionnaire. INTERVENTION: Random allocation to receive 50 mg CC or placebo (PLB) for 12 weeks. OUTCOMES: (1) Clinical features: ADAM and sexual behavior questionnaires; (2) hormonal profile: serum TT, free T, estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sex hormone-binding globulin (SHBG); (3) body composition: BMI, waist circumference, and bioelectric impedance analysis; (4) metabolic profile: blood pressure, fasting blood glucose, HbA1c, insulin, HOMA-IR, and lipid profile; (5) endothelial function: flow-mediated dilation of the brachial artery, quantitative assessment of endothelial progenitor cells and serum sICAM-1, sVCAM-1, and selectin-sE levels; (6) safety aspects: hematocrit, serum prostate-specific antigen, International Prostate Symptom Score, and self-reported adverse effects. RESULTS: There was an improvement in one sexual complaint (weaker erections; P < 0.001); increases (P < 0.001) in TT, free T, E2, LH, FSH, and SHBG; and improvements in lean mass (P < 0.001), fat-free mass (P = 0.004), and muscle mass (P < 0.001) in the CC group. CC reduced HDL (P < 0.001). No statistically significant differences were seen in endothelial function. CONCLUSIONS: CC appeared to effectively improve the hormonal profile and body composition. CC may be an alternative treatment for MOSH in adult men.


Assuntos
Clomifeno/uso terapêutico , Antagonistas de Estrogênios/uso terapêutico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Obesidade/complicações , Adulto , Método Duplo-Cego , Humanos , Masculino
4.
Med Sci Sports Exerc ; 50(7): 1367-1376, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29432326

RESUMO

INTRODUCTION: Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated. OBJECTIVE: This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma. METHODS: Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment. RESULTS: After 3 months, the WL + E group presented a significant increase in daily step counts (3068 ± 2325 vs 729 ± 1118 steps per day) and the number of asthma symptom-free days (14.5 ± 9.6 vs 8.6 ± 11.4 d·month) compared with the WL + S group. The proportion of participants with improvements in depression symptoms (76.4% vs 16.6%) and a lower risk of developing obstructive sleep apnea (56.5% vs 16.3%) was greater in the WL + E group than that in the WL + S group (P < 0.05). Significant improvements in sleep efficiency (6.6% ± 5.1% vs 1.3% ± 4.7%) and latency (-3.7 ± 5.9 vs 0.2 ± 5.6 min) were also observed in the WL + E group. CONCLUSIONS: Our results strongly suggest that exercise training plus a weight loss program improves DLPA, sleep efficiency, and depression and asthma symptoms in obese adults with asthma.


Assuntos
Asma/complicações , Terapia por Exercício , Exercício Físico , Obesidade/complicações , Obesidade/terapia , Actigrafia , Adulto , Ansiedade/complicações , Comorbidade , Depressão/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Treinamento de Resistência , Sono , Apneia Obstrutiva do Sono/complicações , Programas de Redução de Peso
5.
J Pers Med ; 8(1)2018 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-29382185

RESUMO

Childhood obesity is a major public health problem. It has a direct impact on the quality of life of children and adolescents, as well as on their future risk of developing chronic diseases. Dietary patterns rich in fats and sugars and lacking dietary fibers, vitamins, and minerals, as well as lack of physical exercise have been associated with the rise of obesity prevalence. However, factors that contribute to the preference for foods rich in these nutrients are not well established. Taste is recognized as an important predictor of food choices, and polymorphisms in taste-related genes may explain the variability of taste preference and food intake. The aim of this research is to evaluate the influence of polymorphisms of the sweet taste receptor gene TAS1R2 on diet and metabolic profile in obese children and adolescents. A cross-sectional study with 513 obese children and adolescents and 135 normal-weight children was carried out. A molecular study was performed for the single nucleotide polymorphisms (SNPs) rs9701796 and rs35874116 of TAS1R2, and dietary intake, anthropometric parameters (weight, height, waist circumference, waist-to-height ratio (WHtR)), and metabolic profile (including fasting glucose, insulin, triglyceride, high-density lipoprotein (HDL)-cholesterol, and leptin levels) were analyzed. The variant rs9701796 was associated with increased waist-height ratio, as well as with a higher chocolate powder intake in obese children. The variant rs35874116 was associated with a lower dietary fiber intake. In conclusion, there was no relationship between genotypes and risk of obesity. Obese adolescents carrying the serine allele of SNP rs9701796 in TAS1R2 showed higher waist-to-height ratio and chocolate powder intake, whereas those carrying the valine allele of SNP rs35874116 in TAS1R2 were characterized by lower dietary fiber intake.

6.
Surg Laparosc Endosc Percutan Tech ; 27(4): e83-e86, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28731953

RESUMO

INTRODUCTION: The intragastric balloon (IGB) is an endoscopic device for the treatment of obesity. Best results are observed in patients who follow a dietary program but few studies have assessed the results of this treatment in patients with different degrees of obesity. AIM: The aim of this study is to compare the efficacy of IGB in patients with different degrees of obesity. METHOD: A total of 2002 patients with IGB were retrospectively evaluated and were divided into groups according to initial body mass index (BMI) range, as follows: group 1, 27 to 29.9 kg/m; group 2, 30 to 34.9 kg/m; group 3, 35 to 39.9 kg/m; group 4, 40 to 44.9 kg/m; group 5, ≥45 kg/m. Weight was assessed in 3 different times: before (T0), 1 month (T1), 6 months (T2), and 6 months after removal of the IGB (T3). RESULTS: A total of 946 patients lost follow-up. Overall, 40 (3.78%) removed the device before programmed by intolerance, and 1016 patients completed the 6-month treatment. The mean weight loss was 18.9%, excess weight loss 60.1% and an BMI reduction of 6.76 points. 6 months after removal of the balloon 842 patients had continued follow-up (82.8%). At this time, weight loss was 19.84%, excess weight loss was 59.49%, and BMI reduction of 7.06 points. In all groups there was statistical difference between the times T0 and T1 and between T1 and T2 (P<0.001). There was no statistical difference between T2 and T3, in any group. CONCLUSION: IGB provided sustained weight loss in patients who remained in dietary follow-up for 1 year.


Assuntos
Balão Gástrico , Obesidade/cirurgia , Perda de Peso/fisiologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Diabetol Metab Syndr ; 9: 44, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28580018

RESUMO

The prevalence of obesity increases worldwide. Treating obesity and its associated health problems has a significant economic impact on health care systems. The unsatisfactory long-term outcomes observed in the obesity treatment are due to its complex pathophysiology and the inherent difficulties associated with maintenance of lifestyle modifications. Determined by genetic and environmental factors, obesity has been officially recognized as a chronic disease, an action that allowed the recognition of anti-obesity drugs as legitimate therapeutic options to address the growing obesity endemic. Like other chronic diseases, obesity requires long-term treatment. Pharmacological interventions, when used as an adjunct to lifestyle changes, are useful to facilitate clinically meaningful weight loss, which may impact on obesity-associated comorbid conditions. In the past, medications for weight reduction were limited. However, the landscape has changed and new drugs provide additional options for weight management. Among the new drugs, liraglutide is the most studied, especially regarding its effects on the limbic system. As an adjunct to a reduced-calorie diet and increased physical activity, treatment with liraglutide 3.0 mg provides a statistically significant and clinically meaningful weight loss. Liraglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist that shares 97% homology to native GLP-1. Receptor agonists of GLP-1, including liraglutide, have emerged as effective therapies for type 2 diabetes and obesity. This review will address the major findings concerning the central regulation of appetite and the main studies that evaluated new drugs for obesity treatment, with a greater focus on liraglutide 3.0 mg.

8.
Am J Respir Crit Care Med ; 195(1): 32-42, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-27744739

RESUMO

RATIONALE: Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated. OBJECTIVES: To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers, and lung function. METHODS: Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises. MEASUREMENTS AND MAIN RESULTS: The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile], -0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean ± SD, -6.8% ± 3.5 vs. -3.1% ± 2.6; P < 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml O2 × kg-1 × min-1; P < 0.001). These improvements in the WL + E group were also accompanied by improvements in lung function, antiinflammatory biomarkers, and vitamin D levels, as well as reductions in airway and systemic inflammation. CONCLUSIONS: Adding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients. Clinical trial registered with www.clinicaltrials.gov (NCT 02188940).


Assuntos
Asma/complicações , Exercício Físico , Obesidade/complicações , Programas de Redução de Peso/métodos , Asma/fisiopatologia , Asma/terapia , Biomarcadores/sangue , Restrição Calórica/métodos , Feminino , Humanos , Inflamação/sangue , Inflamação/fisiopatologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Obesidade/terapia , Qualidade de Vida , Treinamento de Resistência , Testes de Função Respiratória
9.
Expert Opin Drug Saf ; 16(1): 27-39, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27732121

RESUMO

INTRODUCTION: Few studies on combination therapies for the treatment of obesity had been conducted until recently, when two fixed-dose combinations, bupropion-naltrexone ER fixed-dose combination and phentermine-topiramate ER titrated-dose combinations were evaluated in clinical studies that ultimately led to FDA approval. Areas covered: In this review, we discuss safety concerns about both combinations, the rationale and history of combination therapies for obesity (including phentermine plus fenfluramine), and possible future new combinations. Expert opinion: Combination therapies are a promising new area in obesity treatment, similar to what occurs with diabetes and hypertension. Safety assessment is highly important due to the high number of potential users on a chronic basis.


Assuntos
Fármacos Antiobesidade/administração & dosagem , Obesidade/tratamento farmacológico , Animais , Fármacos Antiobesidade/efeitos adversos , Fármacos Antiobesidade/uso terapêutico , Bupropiona/administração & dosagem , Bupropiona/efeitos adversos , Bupropiona/uso terapêutico , Preparações de Ação Retardada , Combinação de Medicamentos , Frutose/administração & dosagem , Frutose/efeitos adversos , Frutose/análogos & derivados , Frutose/uso terapêutico , Humanos , Naltrexona/administração & dosagem , Naltrexona/efeitos adversos , Naltrexona/uso terapêutico , Fentermina/administração & dosagem , Fentermina/efeitos adversos , Fentermina/uso terapêutico , Topiramato
13.
J Nutrigenet Nutrigenomics ; 9(5-6): 300-305, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28237985

RESUMO

BACKGROUND/AIMS: Taste is recognized as an important predictor of food choices. Thus, polymorphisms in genes encoding taste receptors may explain the variability in food preference and intake. Here, we aimed to determine whether genetic variation in the CD36 gene affects food intake and risk of obesity. METHODS: A cross-sectional study was conducted with obese Brazilian children and adolescents (n = 466; BMI-for-age z-score [zBMI] 3.29 ± 0.61) and normal-weight children (n = 114; zBMI -0.11 ± 0.7). To assess the obesity risk according to genotypes, a logistic regression adjusted for age and gender was performed. Two 24-h food recalls assessed total energy (kcal/day) and macronutrient (% kcal and g/day) intake, consumption of sweet and fatty tasting foods (portion and g/day), as well as the most commonly consumed foods (mL or g/day). The food portion sizes were measured according to Brazilian guidelines. The genetic variant rs1761667 (A/G) in CD36 was genotyped by real-time PCR. RESULTS: We found no relationship between rs1761667 genotypes and obesity risk. A significant genetic association between CD36 genotype and fat intake was observed for the A allele of rs1761667, which was associated with a decreased intake of total fat (g/day) (p = 0.01), polyunsaturated and monounsaturated fatty acids (% kcal and g/day), total sugars (g/day) (p = 0.01), fatty foods (portion and g/day) (p < 0.001 for both), and vegetable oils (mL/day) (p = 0.02) only in obese subjects. No differences were found between normal-weight children. CONCLUSION: The A allele of the rs1761667 single nucleotide polymorphism in CD36 is associated with decreased fat and sugar intake in obese children and adolescents.


Assuntos
Antígenos CD36/genética , Ingestão de Alimentos/genética , Preferências Alimentares , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Brasil , Criança , Estudos Transversais , Gorduras na Dieta/administração & dosagem , Açúcares da Dieta/administração & dosagem , Comportamento Alimentar , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Fatores de Risco , Percepção Gustatória/genética
14.
J Clin Endocrinol Metab ; 101(3): 1104-12, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26713821

RESUMO

CONTEXT: Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment. OBJECTIVE: To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet. DESIGN: Single-center, prospective controlled trial. SETTING: Academic medical center. PARTICIPANTS: Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers). INTERVENTION: Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months. OUTCOME MEASUREMENTS: clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls. RESULTS: Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests. CONCLUSIONS: Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/psicologia , Obesidade/psicologia , Obesidade/terapia , Perda de Peso/fisiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Disfunção Cognitiva/complicações , Aconselhamento , Função Executiva/fisiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Obesidade/complicações , Programas de Redução de Peso
15.
BMC Pulm Med ; 15: 124, 2015 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-26487563

RESUMO

BACKGROUND: Asthma and obesity are public health problems with increasing prevalence worldwide. Clinical and epidemiologic studies have demonstrated that obese asthmatics have worse clinical control and health related quality of life (HRQL) despite an optimized medical treatment. Bariatric surgery is successful to weight-loss and improves asthma control; however, the benefits of nonsurgical interventions remain unknown. METHODS/DESIGN: This is a randomized controlled trial with 2-arms parallel. Fifty-five moderate or severe asthmatics with grade II obesity (BMI ≥ 35 kg/m(2)) under optimized medication will be randomly assigned into either weight-loss program + sham (WL + S group) or weight-loss program + exercise (WL + E group). The weight loss program will be the same for both groups including nutrition and psychological therapies (every 15 days, total of 6 sessions, 60 min each). Exercise program will include aerobic and resistance muscle training while sham treatment will include a breathing and stretching program (both programs twice a week, 3 months, 60 min each session). The primary outcome variable will be asthma clinical control. Secondary outcomes include HRQL, levels of depression and anxiety, lung function, daily life physical activity, body composition, maximal aerobic capacity, strength muscle and sleep disorders. Potential mechanism (changes in lung mechanical and airway/systemic inflammation) will also be examined to explain the benefits in both groups. DISCUSSION: This study will bring a significant contribution to the literature evaluating the effects of exercise conditioning in a weight loss intervention in obese asthmatics as well as will evaluate possible involved mechanisms. TRIAL REGISTRATION: NCT02188940.


Assuntos
Asma/fisiopatologia , Terapia por Exercício/métodos , Obesidade/terapia , Qualidade de Vida , Programas de Redução de Peso/métodos , Acelerometria , Ansiedade/psicologia , Asma/complicações , Asma/psicologia , Terapia Comportamental , Composição Corporal , Testes Respiratórios , Depressão/psicologia , Teste de Esforço , Tolerância ao Exercício , Humanos , Atividade Motora , Força Muscular , Óxido Nítrico/análise , Obesidade/complicações , Obesidade/psicologia , Qualidade de Vida/psicologia , Treinamento de Resistência/métodos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília , Espirometria , Resultado do Tratamento
16.
Endocrine ; 49(3): 653-8, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25948074

RESUMO

Polymorphisms near the MC4R gene may be related to an increased risk for obesity, but studies of variations in this gene and its relation to cardiometabolic profiles and food intake are scarce and controversial. The aim of this study is to evaluate the influence of the variants rs12970134 and rs17782313 near the MC4R gene in food intake, binge eating (BE) behavior, anthropometric parameters, body composition, metabolic profile, and cardiometabolic risk factors in obese children and adolescents. This is a cross-sectional study that included obese children and adolescents. We evaluated anthropometric, metabolic parameters and cardiometabolic risk factors, including hypertension, impaired fasting glucose, hypertriglyceridemia, and low HDL-cholesterol. BE was assessed through the BE scale, and a 24-h recall was used to evaluate total caloric intake and percentage of macronutrients and types of dietary fat. The MC4R variants rs12970134 and rs17782313 were genotyped using TaqMan assay. To assess the magnitude of risk, a logistic regression adjusted for Z-BMI, age, and gender was performed, adopting the significance level of 0.05. The study included 518 subjects (52.1 % girls, 12.7 ± 2.7 years old, Z-BMI = 3.24 ± 0.57). Carriers of the variant rs17782313 exhibit increased triglyceride levels (108 ± 48 vs. 119 ± 54, p = 0.034) and an increased risk of hypertriglyceridemia (OR 1.985, 95 % CI 1.288-3.057, p = 0.002). There was no association of the SNP rs12970134 with clinical, metabolic, or nutritional parameters. The variant rs12970134 and rs17782313 did not influence food intake or the presence of BE. The variant rs17782313 is associated with an increased risk of hypertriglyceridemia in obese children and adolescents.


Assuntos
Obesidade/sangue , Obesidade/genética , Receptor Tipo 4 de Melanocortina/genética , Triglicerídeos/sangue , Adolescente , Antropometria , Transtorno da Compulsão Alimentar/genética , Transtorno da Compulsão Alimentar/psicologia , Composição Corporal/genética , Criança , Estudos de Coortes , Estudos Transversais , DNA/genética , Ingestão de Alimentos/genética , Feminino , Frequência do Gene , Variação Genética , Humanos , Masculino , Obesidade/psicologia , Polimorfismo Genético , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Adulto Jovem
17.
Arq. bras. endocrinol. metab ; 58(9): 875-888, 12/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-732182

RESUMO

Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88.


A obesidade é um problema de saúde pública, está associada com aumento do risco de mortalidade e de desenvolver diversas comorbidades e diminui a expectativa de vida. A cirurgia bariátrica é o tratamento mais eficaz para pacientes com obesidade mórbida, reduzindo o desenvolvimento de novas comorbidades, a utilização dos cuidados de saúde e a mortalidade. A criação de centros de excelência com equipes interdisciplinares em cirurgia bariátrica vem reduzindo a mortalidade operatória no decorrer do tempo, melhorando a segurança e a qualidade cirúrgica. O endocrinologista faz parte da equipe interdisciplinar. O objetivo desta revisão é fornecer aos endocrinologistas, médicos e prestadores de cuidados de saúde elementos cruciais de boas práticas clínicas no tratamento de pacientes com obesidade mórbida candidatos à cirurgia bariátrica. Essas informações incluem indicações formais e contraindicações para as operações bariátricas, descrição das operações bariátricas e metabólicas habituais, bem como tratamentos endoscópicos, avaliação pré-operatória, incluindo avaliação cardiorrespiratória psicológica, metabólica e no pós-operatório, dieta com refeições progressivamente estagiadas e seguimento com suplementação nutricional e monitoramento de deficiências de micronutrientes, complicações cirúrgicas, suspensão de medicamentos em pacientes diabéticos tipo 2, síndrome de dumping e hipoglicemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88.


Assuntos
Humanos , Cirurgia Bariátrica/métodos , /epidemiologia , Endocrinologia , Obesidade Mórbida/cirurgia , Guias de Prática Clínica como Assunto , Apneia Obstrutiva do Sono/epidemiologia , Cirurgia Bariátrica , Desvio Biliopancreático/métodos , Comorbidade , Suplementos Nutricionais , /terapia , Dieta/normas , Síndrome de Esvaziamento Rápido/prevenção & controle , Balão Gástrico , Gastrectomia/métodos , Hipoglicemia/prevenção & controle , Ilustração Médica , Obesidade Mórbida/epidemiologia , Equipe de Assistência ao Paciente , Cuidados Pós-Operatórios , Período Pós-Operatório , Cuidados Pré-Operatórios , Apneia Obstrutiva do Sono/terapia , Perda de Peso
18.
Arq Bras Endocrinol Metabol ; 58(9): 875-88, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25627042

RESUMO

Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia.


Assuntos
Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/epidemiologia , Endocrinologia , Obesidade Mórbida/cirurgia , Guias de Prática Clínica como Assunto , Apneia Obstrutiva do Sono/epidemiologia , Desvio Biliopancreático/métodos , Comorbidade , Contraindicações , Diabetes Mellitus Tipo 2/terapia , Dieta/normas , Suplementos Nutricionais , Síndrome de Esvaziamento Rápido/prevenção & controle , Gastrectomia/métodos , Balão Gástrico , Humanos , Hipoglicemia/prevenção & controle , Ilustração Médica , Obesidade Mórbida/epidemiologia , Equipe de Assistência ao Paciente , Cuidados Pós-Operatórios , Período Pós-Operatório , Cuidados Pré-Operatórios , Apneia Obstrutiva do Sono/terapia , Perda de Peso
19.
São Paulo; Roca; 2002. 1v p.
Monografia em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-1081686
20.
Arq Bras Endocrinol Metabol ; 56(3): 178-83, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22666733

RESUMO

OBJECTIVE: To analyze the LEPR gene in obese children and to investigate the associations between molecular findings and anthropometric and metabolic features. SUBJECTS AND METHODS: Thirty-two patients were evaluated regarding anthropometric characteristics, blood pressure, heart rate, serum glucose, insulin, leptin levels, and lipid profile. The molecular study consisted of the amplification and automatic sequencing of the coding region of LEPR in order to investigate new mutations. RESULTS: We identified a high prevalence of metabolic disorders: impaired fasting glucose in 12.5% of the patients, elevated HOMA-IR in 85.7%, low HDL-cholesterol levels in 46.9%, high triglyceride levels in 40.6%, and hypertension in 58.6% of the patients. The molecular study identified 6 already described allelic variants: rs1137100 (exon-2), rs1137101 (exon-4), rs1805134 (exon-7), rs8179183 (exon-12), rs1805096 (exon-18), and the deletion/insertion of the pentanucleotide CTTTA at 3'untranslated region. CONCLUSIONS: The frequency of alleles observed in this cohort is similar to that described in the literature, and was not correlated with any clinical feature. The molecular findings in the analysis of the LEPR did not seem to be implicated in the etiology of obesity in these patients.


Assuntos
Glicemia/análise , Insulina/sangue , Leptina/sangue , Mutação , Obesidade/genética , Receptores para Leptina/genética , Idade de Início , Índice de Massa Corporal , Brasil , Criança , Feminino , Frequência do Gene , Humanos , Masculino , Obesidade/metabolismo , Polimorfismo Genético
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