Riesgo cardiovascular, dislipemias e indicación de estatinas en una población de obesos mórbidos

Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados ​​478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis.

BACKGROUND: The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children. METHODS: We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure. RESULTS: In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups. CONCLUSION: Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

Association between visceral adiposity index and cancer risk in the UK Biobank cohort.

BACKGROUND: The visceral adiposity index (VAI) is a marker of visceral fat accumulation and metabolic dysfunction, but there is limited evidence of its association with cancer. The objective of this study was to investigate associations between the VAI and both incident cancer at 23 sites and all-cause cancer. METHODS: In total, 385,477 participants (53.3% women; mean age, 56.3 years) from the UK Biobank prospective cohort were included in this study. The median follow-up was 8.2 years (interquartile range, 7.3-8.9 years). The VAI was calculated using formula the published by Amato et al. and was categorized into sex-specific tertiles. Twenty-four incident cancers were the outcomes. Cox proportional hazard models were adjusted for sociodemographics, lifestyle factors, and multimorbidity counts. RESULTS: Over the follow-up period, 47,882 individuals developed cancer. In the fully adjusted models, the VAI was associated with a higher risk of six cancer sites. Individuals in the highest tertile, compared with those in the lowest tertile, had higher risks of uterine (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.76-2.49), gallbladder (HR, 1.83; 95% CI, 1.26-2.66), kidney (HR, 1.39; 95% CI, 1.18-1.64), liver (HR, 1.25; 95% CI, 1.00-1.56), colorectal (HR, 1.14; 95% CI, 1.05-1.24), and breast (HR, 1.11; 95% CI, 1.03-1.19) cancers and of all-cause cancer (HR, 1.05). There was no evidence of a nonlinear association between the VAI and cancer risk. CONCLUSIONS: The VAI was associated with six cancer sites and with all-cause cancer. The prognostic and etiologic roles of visceral fat accumulation and dysfunction in cancer warrant further research.

Maternal obesity induces sex-specific changes in the endocannabinoid system of the hypothalamus and dorsal hippocampus of offspring associated with anxiety-like behavior in adolescent female rats.

Maternal obesity during perinatal period increases the risk of metabolic and behavioral deleterious outcomes in the offspring, since it is critical for brain development, maturation, and reorganization. These processes are highly modulated by the endocannabinoid system (ECS), which comprises the main lipid ligands anandamide and 2-arachidonoylglycerol, cannabinoid receptors 1 and 2 (CB1R and CB2R), and several metabolizing enzymes. The ECS is overactivated in obesity and it contributes to the physiological activity of the hypothalamus-pituitary-adrenal (HPA) axis, promoting stress relief. We have previously demonstrated that maternal high-fat diet during gestation and lactation programmed the food preference for fat in adolescent male offspring and adult male and female offspring. In the present study, we hypothesized that maternal diet-induced obesity would induce sex-specific changes of the ECS in the hypothalamus and dorsal hippocampus of rat offspring associated with dysregulation of the HPA axis and stress-related behavior in adolescence. Rat dams were fed a control (C) or an obesogenic high-fat high-sugar diet (OD) for nine weeks prior to mating and throughout gestation and lactation. Maternal obesity differentially altered the CB1R in the hypothalamus of neonate offspring, with significant increase in male but not in female pups, associated with decreased CB2R prior to obesity development. In adolescence, maternal obesity induced anxiety-like behavior only in adolescent females which was associated with increased content of CB1R in the dorsal hippocampus. Our findings suggest that the early origins of anxiety disorders induced by maternal exposome is associated with dysregulation of the brain ECS, with females being more susceptible.

Genetic and Anthropometric Interplay: How Waist-to-Hip Ratio Modulates LDL-c Levels in Mexican Population.

BACKGROUND/OBJECTIVES: Genetic factors contribute to the physiopathology of obesity and its comorbidities. This study aimed to investigate the association of the SNPs ABCA1 (rs9282541), ADIPOQ (rs2241766), FTO (rs9939609), GRB14 (rs10195252), and LEPR (rs1805134) with various clinical, anthropometric, and biochemical variables. METHODS: The study included 396 Mexican mestizo individuals with obesity and 142 individuals with normal weight. Biochemical markers were evaluated from peripheral blood samples, and SNP genotyping was performed using PCR with TaqMan probes. A genetic risk score (GRS) was computed using an additive model. RESULTS: No significant associations were found between the SNPs ABCA1, ADIPOQ, FTO, and LEPR with obesity. However, the T allele of the GRB14 SNP was significantly associated with obesity (χ2 = 5.93, p = 0.01; OR = 1.52; 95% CI: 1.08-2.12). A multivariate linear regression model (adjusted R-squared: 0.1253; p < 0.001) predicting LDL-c levels among all participants (n = 538) identified significant (p < 0.05) beta coefficients for several anthropometric and biochemical variables, as well as for the GRS. Additionally, the interaction between the GRS and the waist-to-hip ratio (WHR) showed a negative beta coefficient (BC = -26.5307; p = 0.014). Participants with a WHR < 0.839 showed no effect of GRS on LDL-c concentration, while those with a WHR > 0.839 exhibited a greater effect of GRS (~9) at lower LDL-c concentrations (~50 mg/dL) and a lesser effect of GRS (~7) at higher LDL-c concentrations (~250 mg/dL). CONCLUSIONS: A significant interaction between genetics and WHR influences LDL-c in Mexicans, which may contribute to the prevention and clinical management of dyslipidemia and cardiovascular disease.

Prevalence and associated risk factors of post-COVID-19 syndrome in healthcare workers.

Given the global burden of COVID-19 among healthcare workers (HCWs), it is expected that they face an elevated risk of developing post-COVID-19 syndrome. The objectives of this study were to evaluate the prevalence of post-COVID-19 syndrome and associated risk factors in HCWs followed for a median time of 18 months by conducting a retrospective cohort study. All HCWs with confirmed COVID-19 during the period from January 2021 to December 2022 were included in the study. HCWs were regularly assessed after COVID-19 diagnosis, so post-COVID-19 syndrome data could be collected. During the study period, 463 HCWs were included in the study, 227 (49.0%) of which experienced post-COVID-19 syndrome. The most common persistent symptoms were fatigue (n = 147 [32.5%]), memory disorders (n = 98 [21.5%]), dyspnea (n = 73 [16.0%]), anxiety/depression (n = 69 [15.0%]), and cough (n = 43 [9.4%]). Female sex and obesity were statistically associated with the development of post-COVID-19 syndrome. A high prevalence of post-COVID-19 syndrome in HCWs was found. Female sex and obesity appear to be risk factors associated with a higher prevalence of post-COVID-19 syndrome. Special attention should be given to these patients with risk factors during follow-up in the COVID-19 recovery period.

Patterns of beverages consumption and prevalence of non-communicable chronic diseases.

Beverages consumption influences diet quality in general and has been associated with the development of non-communicable chronic diseases (NCCD). We aimed to verify the association between beverage consumption patterns and the prevalence of NCCD. A cross-sectional household and population-based study was conducted with 489 individuals aged 20 years and older. The presence of NCCD (arterial hypertension, diabetes, cancer and hypercholesterolemia) was obtained by self-report, while obesity was diagnosed by measuring body weight, height and waist circumference. Beverage consumption patterns were obtained by principal component analysis. The association between beverages patterns and the prevalence of NCCD was verified using Poisson regression, expressed as prevalence ratio (PR) and adjusted for potential confounding factors. Three beverage patterns were identified: 'ultra-processed beverages', 'alcoholic beverages' and 'healthy beverages'. Individuals with greater adherence to the Ultra-processed Beverages Pattern had a 2·77 times higher prevalence of cancer (PR: 3·77; 95 % CI 1·57, 9·07). Higher adherence to the Alcoholic Beverages Pattern was associated with a higher prevalence of obesity (PR: 1·97; 95 % CI 1·13, 3·44). In contrast, individuals in the second tertile of adherence to the Healthy Beverages Pattern had a 39 % lower prevalence of hypercholesterolemia (PR: 0·61; 95 % CI 0·40, 0·92), and individuals in the third tertile had a 10 % lower prevalence of abdominal obesity estimated by the waist-to-height ratio (PR: 0·90; 95 % CI 0·83, 0·97). Beverage consumption patterns may be associated with a higher prevalence of NCCD, regardless of other risk factors. It is therefore important to conduct more studies investigating the impact of beverages patterns on health.

Copper biomarkers and their relationship with parameters of insulin resistance in obese women.

Some studies have demonstrated the involvement of high concentrations of copper in the manifestation of insulin resistance in individuals with obesity. The objective of this study was to evaluate the copper nutritional status and its relationship with parameters of glycemic control in women with obesity. An observational case-control clinical study involving 203 women aged between 20 and 50 years, divided into two groups: obese (n = 84) and eutrophic (n = 119). Body weight, height and waist, hip and neck circumferences, dietary copper intake, copper biomarkers, determine ceruloplasmin activity and glycemic control parameters were measured. It was observed that women with obesity had higher copper concentrations in plasma and lower concentrations in erythrocytes when compared to the control group. Analysis of glycemic control parameters revealed a statistically significant difference in fasting blood glucose (p < 0.05) between groups. The study identified a significant positive correlation between plasma copper and fasting insulin values and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index (p < 0.05). The results of this study demonstrate that obese women have high copper concentrations in plasma and lower concentrations in erythrocytes. Furthermore, the significant positive correlation between plasma copper and fasting insulin and HOMA-IR index suggests the influence of this mineral on glycemic control parameters in obese women.

Copper biomarkers and their relationship with dyslipidemia in women with obesity.

Adipose tissue dysfunction influences the development of dyslipidemias associated with obesity, however, the mechanisms are still unclear. In this sense, the literature highlights the role of copper in cholesterol synthesis, contributing to the increase in concentrations of this lipid fraction and consequently to the manifestation of dyslipidemia. The objective of the study was to investigate the relationship between copper parameters and lipid profile markers in women with obesity. This is a cross-sectional study involving women aged 20 to 50 years divided into a case group (BMI ≥ 35 kg/m2) and a control group (BMI between 18.5 and 24.9 kg/m2). Copper concentrations in plasma and erythrocytes were determined by inductively coupled plasma optical emission spectrophotometry and ceruloplasmin activity by spectrophotometry. The lipid fractions were analyzed according to the enzymatic colorimetric method, using an automatic biochemical analyzer. Participants with obesity had elevated concentrations of copper in plasma and reduced concentrations in erythrocytes compared to the control group, but there was no significant difference in ceruloplasmin activity between the groups. The research does not identify a correlation between copper parameters and serum concentrations of lipid fractions, which does not allow inferring the role of copper in the manifestation of dyslipidemia in obesity.

Mini Review: The gut microbiota as a link between Alzheimer's disease and obesity.

Alzheimer's disease (AD) is a degenerative disease that causes a progressive decline in memory and thinking skills. Over the past few years, diverse studies have shown that there is no single cause of AD; instead, it has been reported that factors such as genetics, lifestyle, and environment contribute to the pathogenesis of the disease. In this sense, it has been shown that obesity during middle age is one of the most prominent modifiable risk factors for AD. Of the multiple potential mechanisms linking obesity and AD, the gut microbiota (GM) has gained increasing attention in recent years. However, the underlying mechanisms that connect the GM with the process of neurodegeneration remain unclear. Through this narrative review, we present a comprehensive understanding of how alterations in the GM of people with obesity may result in systemic inflammation and affect pathways related to the pathogenesis of AD. We conclude with an analysis of the relationship between the GM and insulin resistance, a risk factor for AD that is highly prevalent in people with obesity. Understanding the crosstalk between obesity, the GM, and the pathogenesis of AD will help to design new strategies aimed at preventing neurodegeneration.

Aging mitochondria in the context of SARS-CoV-2: exploring interactions and implications.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented global challenges with a diverse clinical spectrum, including severe respiratory complications and systemic effects. This review explores the intricate relationship between mitochondrial dysfunction, aging, and obesity in COVID-19. Mitochondria are vital for cellular energy provision and resilience against age-related macromolecule damage accumulation. They manage energy allocation in cells, activating adaptive responses and stress signals such as redox imbalance and innate immunity activation. As organisms age, mitochondrial function diminishes. Aging and obesity, linked to mitochondrial dysfunction, compromise the antiviral response, affecting the release of interferons, and worsening COVID-19 severity. Furthermore, the development of post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID has been associated with altered energy metabolism, and chronic immune dysregulation derived from mitochondrial dysfunction. Understanding the interplay between mitochondria, aging, obesity, and viral infections provides insights into COVID-19 pathogenesis. Targeting mitochondrial health may offer potential therapeutic strategies to mitigate severe outcomes and address long-term consequences in infected individuals.

Oral glucose tolerance test curve shape in Mexican children and adolescents with and without obesity.

OBJECTIVES: Mexican children with obesity are at a higher risk of developing type 2 diabetes mellitus (T2DM). The aim of the study was to compare oral glucose tolerance test (OGTT) characteristics: time of peak glucose, glucose level ≥155 mg/dL at 1 h, presence of metabolic syndrome (MetS), sensitivity, secretion, and oral disposition index (oDI) in children with and without obesity, according to oral glucose tolerance curve shape: monophasic or biphasic. METHODS: Cross-sectional study including 143 children. Groups were divided into (a) obese: biphasic (B-Ob) (n=55) and monophasic (M-Ob) (n=50), (b) without obesity: biphasic (B-NonOb) (n=20) and monophasic (M-NonOb) (n=18). RESULTS: Late glucose peak was more frequent in the M-Ob group (p<0.001). Glucose levels ≥155 mg/dL and MetS were more frequent in the M-Ob group but did not show significance. The groups with obesity (biphasic and monophasic) had higher indices of insulin resistance and insulin secretion compared to the nonobese groups (biphasic and monophasic) (p<0.001). AUC glucose was higher in the M-Ob group (p<0.05), and AUC insulin was higher in the M-NonOb group. oDI (Matsuda) was significantly lower in the M-Ob group compared to the other groups (p<0.001), and oDI-HOMA IR was higher in M-NonOb group (p=0.03). CONCLUSIONS: All OGTT parameters could help to identify Mexican children at increased risk of developing T2DM, not only fasting plasma glucose and 2 h glucose. M-Ob in non-T2DM Mexican children reflects an early defect in glucose metabolism. Higher level of IR indexes in M-NonOb vs. B-NonOb could indicate an increased risk for T2DM of genetic origin.

[Metabolic alterations observed in patients undergoing endocrinological follow-up during the first year of confinement due to Covid-19] / Alteraciones metabólicas observadas en pacientes en seguimiento clínico durante el primer año de confinamiento por Covid-19.

Introduction: At the beginning of the COVID-19 pandemic, confinement measures were applied in many states around the world, producing changes in lifestyle and health habits, whose metabolic impact was different in different populations. Objectives: Describe the metabolic and anthropometric changes in office patients in the City of Córdoba during the confinement period and determine possible associated factors. Methods: Retrospective analytical observational study based on the review of the medical records of patients seen in an endocrinology clinic in Córdoba, Argentina. They were followed up during the 1-year period by evaluating metabolic and anthropometric characteristics. Results: 149 patients were included, of which 116 (77.9%) were female and the median:IQR age was 50:36.5-58 years. At the end of follow-up, a significant increase in alcohol consumption (18.1% vs 11.4%, p=0.001) was observed, as well as the number of diabetic patients (diagnosis of 20 new cases). 49.67% of patients increased their body weight, with a median of 3.1 kg (IQR 25-75%: 1.4-7.5 kg). Patients who had longer follow-up (3 or more controls during the year) decreased their Body Mass Index and increased physical activity. Conclusions: Although confinement was generally associated with an increase in obesity, diabetes and consumption of toxic substances, in patients who were monitored more frequently, better control of body weight and increased activity was observed. physical.

Introducción: Al comienzo de la pandemia por COVID-19 se aplicaron medidas de confinamiento en muchas estados del mundo, produciendo cambios en los hábitos de vida y salud, cuyo impacto metabólico fue diferente en distintas poblaciones. Objetivos: Describir los cambios metabólicos y antropométricos en pacientes de consultorio en la Ciudad de Córdoba durante el período de confinamiento y determinar posibles factores asociados. Métodos: Estudio observacional retrospectivo analítico a partir de la revisión de las historias clínicas de pacientes atendidos en consultorio de endocrinología en Córdoba, Argentina. Se realizó el seguimiento de estos durante el período de 1 año evaluando características metabólicas y antropométricas. Métodos: Estudio observacional retrospectivo analítico a partir de la revisión de las historias clínicas de pacientes atendidos en consultorio de endocrinología en Córdoba, Argentina. Se realizó el seguimiento de estos durante el período de 1 año evaluando características metabólicas y antropométricas. Resultados: Se incluyeron 149 pacientes, de los cuales 116(77,9%) eran de sexo femenino y la mediana:RIC de edad fue 50:36,5-58 años. Al final del seguimiento se observó un aumento significativo del consumo de alcohol (18,1% vs 11,4%, p=0,001), así como también el número de pacientes diabéticos (diagnóstico de 20 nuevos casos). El 49,67% de los pacientes incrementó su peso corporal, con una mediana de 3,1Kg(RIC 25-75%: 1,4-7,5 kg). Los pacientes que tuvieron mayor seguimiento (3 o más controles durante el año), disminuyeron su Índice de masa corporal y aumento de actividad física. Conclusiones: Si bien el confinamiento se asoció en términos generales a un aumento del obesidad, diabetes y consumo de sustancias tóxicas, en los pacientes a los cuales se les realizó un seguimiento más frecuente, se observó mejor control del peso corporal y aumento de la actividad física.

Screen time, sleep duration, leisure physical activity, obesity, and cardiometabolic risk in children and adolescents: a cross-lagged 2-year study.

BACKGROUND: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up. METHODS: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented. RESULTS: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016. CONCLUSION: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.

Differences in body dissatisfaction between individuals with and without stigma toward obesity: A study of preadolescents and adolescents.

INTRODUCTION: Previous studies have focused on understanding the biopsychosocial implications of obesity stigma and have made proposals to minimize its negative consequences, as well as recommendations to eliminate or reduce this stigma; however, knowing which individuals stigmatize obesity and why will allow us to have a broader picture of stigmatization and thus help in planning interventions with greater impact. OBJECTIVE: The aims were to describe the stigmatization toward obesity in preadolescents and adolescents and to determine whether there are differences in body dissatisfaction, abnormal eating behaviors and self-esteem among those with and without stigma toward obesity. METHODS: A total of 307 preadolescents and 349 adolescents answered a set of questionnaires that evaluated abnormal eating behaviors, body dissatisfaction, self-esteem and stigma. RESULTS: Fifty-nine percent of the participants stigmatized individuals with obesity, with preadolescents having the greatest stigma levels. Differences were observed only in body dissatisfaction, where the group of preadolescents who stigmatized individuals with obesity and the group of adolescents who did not stigmatize individuals with obesity reported higher levels of body dissatisfaction. CONCLUSION: Obesity is stigmatized at early ages, regardless of sex; however, preadolescents with stigma toward obesity and adolescents without stigma toward obesity have greater body dissatisfaction, indicating that body dissatisfaction plays a crucial role in the stigmatization of obesity. LEVEL OF EVIDENCE: Level V, cross-sectional analytical study.

Protocol of Randomized Controlled Community Trial (RCCT) for obesity management in Brazilian primary health care.

BACKGROUND: Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. METHODS: Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". DISCUSSION: The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. TRIAL REGISTRATION: RBR-3vzsyqq and RBR-6pg682m.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management.

PURPOSE: To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers. RECENT FINDINGS: A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

Healthy Change Intervention: A Cluster RCT in Preschooler Mothers in Mexico and the United States.

OBJECTIVE: To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment. METHODS: A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements. RESULTS: Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint. CONCLUSIONS FOR PRACTICE: Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.

Association between dynapenic obesity phenotypes and physical performance in middle-age and older women living in community.

Background: Dynapenic obesity (DO) is the coexistence of excess adipose tissue/body weight and low muscle strength. This condition is associated with an increased risk of suffering from various chronic diseases and physical deterioration in older people. Aim: To analyze the association between DO phenotypes and physical performance in middle-aged women living in the community. Methods: This cross-sectional study was conducted on middle-aged and older women (≥50 years) residing in Guayaquil, Ecuador. Dynapenia was diagnosticated by a handgrip strength (HGS) < 16 kg; obesity was determined based on body mass index (BMI) ≥ 30 kg/m2. Participants were categorized into four groups based on their dynapenia and obesity status: non-dynapenic/non-obesity (ND/NO), obesity/non-dynapenic (O/ND), dynapenic/non-obesity (D/NO) and dynapenic/obesity (D/O). Physical performance was assessed by the Short Physical Performance Battery (SPPB). Results: A total of 171 women were assessed. The median (IQR) age of the sample was 72.0 (17.0) years. Obesity and dynapenia were 35% (n = 60) and 57.8% (n = 99) of the participants, respectively. The prevalence of ND/NO was 25.1% (n = 43), O/ND 17% (n = 29), D/NO 39.8% (n = 68) and DO 18.1% (n = 31). The mean SPPB total score was 6.5 ± 3.2. Participants of D/NO and DO groups presented significantly lower mean SPPB scores (p < 0.001) compared to those of NO/ND and O/ND groups. Conclusion: Women with DO and D/NO exhibited significantly lower SPPB scores, indicating poorer physical performance. These findings emphasize the importance of incorporating a comprehensive assessment of muscle strength and obesity in middle-aged and older women.

Association between dopamine genes, adiposity, food addiction, and eating behavior in Chilean adult.

Background: A frequent consumption of high sugar/fat foods can affect dopamine signaling in the brain and cause sustained stimulation of the reward system. It has been hypothesized that a hypodopaminergic trait results in an individual overeating in order to increase brain DA. Genetic variants in this route have been connected with addiction and eating behaviors. Most studies focus on a specific SNP, and few studies have used multilocus genetic scores, which quantify genetic risk on a continuum. Aim: To assess the relationship between multilocus genetic scores based on multiple gene variants in the dopaminergic pathway and measurements of anthropometry, eating behavior, food reinforcement, and food addiction (FA) in Chilean adults. Methods: We recruited 221 Chilean adults for a cross-sectional study. A standard anthropometric measurement procedure was followed and eating behavior was examined using the Three Factor Eating questionnaire (TFEQ), Food Reinforcement Value Questionnaire (FRVQ), Yale Food Addiction Scale (YFAS) and 24-h diet recall. Multilocus genetic scores were calculated using TaqMan assays (rs1800497-rs1799732-rs6277-rs4680). Results: No differences were found in the entire sample for anthropometric measurements, by MLGS. We found that participants with a score ≥ 2.0 in the MLGS showed higher food choices on the RVFQ and lower energy intake in protein, lipids, SAFA, MUFA, PUFA, dietary cholesterol, omega-3 and Omega-6 fatty acids in the 24-h recall (p < 0.05). Stratified by nutritional condition, the group with obesity had inferior scores on cognitive restriction, greater scores on uncontrolled eating, emotional eating, and responding to palatable food in the RVFQ. Also, in subjects with obesity, there was more food addiction in the group scoring "MLGS ≥2.0 or low dopamine signaling" (53%), compared to the group scored "MLGS <2.0 or high dopamine signaling" (23%) (p-value; 0.05). Emotional Eating scores correlated positively with MLGS in subjects with obesity. Conclusion: In adults with obesity, the MLGS of the dopamine pathway, reflecting hypodopaminergic signaling, was associated with greater scores on food addiction and altered eating behavior traits.