Distribución de sobrepeso, obesidad y conocimiento de complicaciones de los mismos en la población de policías (Estudio realizado en el Comando Departamental de Orden y Seguridad) / Distribution of overweight, obesity and knowledge of complications of the same in the population of police (Study realised in the Departmental Commando of Order and Security)

En las últimas décadas el aumento del porcentaje del sobrepeso y la obesidad se debe principalmente a cambios importantes en la alimentación, el patrón de actividad física y otros factores de índole sociocultural que se asocian a un aumento de la morbilidad y una disminución en la esperanza de vida. Los policías se han constituido en una población de riesgo al adquirir sobrepeso y obesidad ya que cambian sus hábitos de alimentación, el patrón de actividad física y otros de factor sociocultural. El presente trabajo tiene la finalidad de conocer la distribución de sobrepeso y obesidad, y conocimientos de complicaciones de los mismos, por parte de los policías del Comando Departamental de Orden y Seguridad, en octubre del 2007.Para este estudio se elaboró un cuestionario que fue llenado por 115 policías de la institución mencionada. Se pudo evidenciar sobrepeso en un 47 % y obesidad en un 12,1 % de los policías. Tienen conocimiento de las complicaciones del sobrepeso y la obesidad, como ser: la presión alta, ataque al corazón, enfermedades de las articulaciones, alteraciones pulmonares y bajo rendimiento físico en el trabajo; pero, poco conocimiento del cáncer como complicación del sobrepeso y obesidad.

Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America.

Until 60 years ago, fatty heart was an accepted clinical entity. Since then, its very existence has been questioned, despite the fact that 2 of 3 Americans are now obese or overweight and obesity has been shown to be correlated with cardiac functional abnormalities. In 2000, a syndrome of "lipotoxic cardiomyopathy" resembling earlier pathologic descriptions of fatty human hearts was described in rodents, and fatty infiltration of cardiomyocytes was subsequently reported in patients with congestive failure. Now, magnetic resonance spectroscopy has been adapted to permit routine noninvasive screening for fatty heart. The use of this technique in human volunteers indicates that cardiomyocyte fat correlates well with body mass index and is elevated in uncomplicated obesity. It is more severe when glucose tolerance becomes abnormal or diabetes is present. It is associated with impaired diastolic filling, even in seemingly asymptomatic obese volunteers. Because fatty heart can be readily prevented by lifestyle modification and pharmacologic interventions that reduce caloric intake and increase fatty acid oxidation, it seems important to recognize its existence so as to intervene as early as possible.

The value of contrast dobutamine stress echocardiography on detecting coronary artery disease in overweight and obese patients.

BACKGROUND: Dobutamine stress echocardiography (DSE) is an established method of detecting myocardial ischemia. Its diagnostic accuracy solely depends on wall motion assessment. Clear visibility of the left ventricular endocardium is essential for reliable assessment of a wall motion abnormality. However, incremental benefits of contrast DSE for the detection of coronary artery disease (CAD) have not been demonstrated in overweight or obese patients. OBJECTIVES: The purpose of the present study was to test the incremental benefits of contrast DSE in detecting CAD in overweight or obese patients. METHODS: Sixty-two overweight or obese patients (body mass index 26 kg/m(2) to 33 kg/m(2)) underwent DSE with or without contrast and coronary angiography. Contrast-enhanced images were achieved at rest and during peak DSE after administration of SonoVue (Bracco Diagnostics Inc, Italy) or Optison (Mallinckrodt, USA). The endocardial border resolution for each myocardial segment was graded as 0, 1 or 2. A total of 992 segments from 62 subjects were analyzed. The results of DSE with or without contrast were compared with the findings on angiography. RESULTS: The differences in the score grading between the two groups with or without contrast, at rest and during peak DSE were statistically significant (P<0.001). The sensitivity, specificity and accuracy of contrast DSE in detecting CAD, compared with the studies without contrast, were improved (82% versus 70%, 78% versus 67% and 81% versus 69%, respectively). CONCLUSIONS: SonoVue and Optison can enhance left ventricular endocardial border delineation in overweight or obese patients, optimizing the evaluation of wall motion both at rest and during peak stress. This increases the diagnostic value of DSE in detecting CAD.

[Nutrition, weight and pregnancy]. / Ernaering, vekt og svangerskap.

BACKGROUND: Nutrition in pregnancy has only been of moderate interest to Scandinavians, probably because under-nutrition has not been a problem in these populations. This attitude has changed recently for two main reasons. First, the prevalence of overweight has increased markedly among women of fertile ages the last decades. Secondly, there is accumulating evidence that nutrition and growth during foetal life may have long-term influence on the new individual's risk of disease. The present overview discusses these two aspects of nutrition in pregnancy, with special emphasis on the impact of overweight. MATERIAL AND METHODS: The review is based on a recent literature survey, the authors' own research and 25 years of obstetrical experience. RESULTS AND INTERPRETATION: Overweight and obesity in pregnancy is associated with a number of complications during pregnancy and delivery, i.e. preeclampsia, gestational diabetes, foetal macrosomia, intrauterine foetal death and injuries to the mother and infant. More recent data indicate that infants of overweight mothers carry an increased risk of future diabetes, overweight and possibly certain forms of cancer. Differences in nutritional and growth conditions in foetal life seem to "program" the foetus to different predispositions for diseases later in life. Nutrition and nutritional conditions in pregnancy therefore have a transgenerational perspective, and achieving optimal nutrition and levels of physical activity in young women is of special importance.

Comparison of anthropometry and parent-reported height and weight among nine year olds.

BACKGROUND: There is mounting evidence that the prevalence of overweight and obesity in children is reaching epidemic proportions in North America. We compared parent-report vs. measured BMI overweight and obesity prevalence estimates among 9 year olds using the 1996 NLSCY reports published by Willms et al. (2003) and anthropometric measurements from a regional population of public school children. METHODS: Body mass index (BMI) was calculated for 1,497 9-year-old children (males N = 734; females N = 763) from 75 public schools in the Niagara Region of Ontario, Canada. BMI from the 1996 NLSCY was based on parental reports of height and weight of 879 nine year olds. To define overweight and obese children, we used internationally accepted age- and gender-specific cut-offs as defined by Cole et al. (2000). RESULTS: The NLSCY overweight prevalence estimates of boys and girls may overestimate overweight boys and girls by 17% and 10%, respectively. Measured obesity prevalence estimates were similar to parent-reports. CONCLUSIONS: Our results suggest that parental reports of height and weight may inflate prevalence estimates of overweight children, but appear reasonably accurate for estimating obesity. Since prevalence of overweight and obesity are often combined to form a global estimate, reliance on parent-reported height and weight may overstate the magnitude of the problem.

Predictors of weight change in overweight patients with myocardial infarction.

BACKGROUND: Weight loss is recommended among overweight survivors of myocardial infarction (MI). This study describes patterns of weight change among overweight patients with MI and identifies factors associated with weight change. METHODS: A prospective cohort of 1253 overweight or heavier (body mass index [BMI] > or = 25 kg/m2) post-MI patients were enrolled in the 19-center PREMIER study and followed up for 1 year to determine changes in weight. Patients were categorized at 1 month as overweight (BMI = 25-29.9 kg/m2), obese (BMI = 30-39.9 kg/m2), or morbidly obese (BMI > or = 40 kg/m2). Unadjusted percent weight change was assessed at 1 year, and multivariable linear regression was used to identify independent correlates of change. RESULTS: Mean weight change was -0.2% and varied by the severity of baseline obesity (+0.4% for overweight patients, -0.5% for obese patients, and -3.7% for morbidly obese patients [P < .001]). Multivariable analyses revealed the following to be significantly associated with weight change: depression 1 month post-MI (+2.7%, P = .001), lack of health insurance (+2%, P = .01), smoking cessation 1 month post-MI (+2.7% vs current smokers, P < .001), morbid obesity (+4.7% vs overweight patients, P < .0001), and increasing age (-0.8% per decade, P = .001). An interaction between smoking cessation and weight class was detected in that overweight patients who quit had a mean increase of 5.3% (95% CI 3.1%-7.4%), whereas no significant change was observed among obese and morbidly obese patients who quit. CONCLUSIONS: Although post-MI patients had negligible weight loss over 1 year, several sociodemographic, clinical, and lifestyle characteristics were associated with weight change. New, targeted interventions will likely be needed to improve weight management after an MI.

Aerobic fitness and upper extremity strength in patients aged 11 to 21 years with spinal cord dysfunction as compared to ideal weight and overweight controls.

OBJECTIVE: To determine whether the aerobic fitness, upper extremity strength, and body composition in groups of adolescents with mobility impairment due to thoracic and upper lumbar spinal cord injury (SCI) or spina bifida (SB) are significantly different from those in groups of adolescents without mobility impairment who are of normal weight (CTRL) or overweight (OW). SUBJECTS: One hundred fifteen total subjects were evaluated including 59 female (19 SB, 9 SCI, 17 OW, and 14 CTRL) and 56 male (18 SB, 10 SCI, 8 OW, and 20 CTRL) participants aged 11 to 21 years. METHODS: Aerobic fitness was assessed using a ramp protocol with a magnetically braked arm ergometer. Heart rate and oxygen uptake (VO2) were recorded. Peak isokinetic upper arm and shoulder strength values were determined with a dynamometer. Body composition was estimated using dual energy x-ray absorptiometry (DEXA). Male and female subjects were categorized as overweight if their percent body fat by DEXA exceeded 25% and 30%, respectively. Results were analyzed with an ANOVA using the Bonferroni correction. Significance was accepted at P < 0.05. RESULTS: The percent body fat of both the male and female SB and SCI subjects was significantly higher than CTRL but was not different than OW. In general, the shoulder extension and flexion strength in both the SB and SCI males and females was significantly lower than that of the CTRL and OW. The SCI and SB subjects had significantly reduced aerobic capacity (VO2/kg) compared to the CTRL subjects but were not different than the OW subjects. During the maximal exercise test, the SB and SCI subjects reached exhaustion at significantly lower workloads than the CTRL and OW subjects. CONCLUSIONS: Patients age 11 to 21 years with SB and SCI had reduced aerobic capacity that was associated with being overweight and having reduced upper extremity strength. These data suggest that interventions to increase strength and fitness and to manage weight should be recommended in this population.

Body composition and resting energy expenditure in patients aged 11 to 21 years with spinal cord dysfunction compared to controls: comparisons and relationships among the groups.

OBJECTIVES: To compare body composition in patients aged 11 to 21 years with spinal dysfunction due to spinal cord injury (SCI) and spina bifida (SB) vs. able-bodied control (CTRL) and able-bodied overweight (OW) groups and to examine the relationships between resting energy expenditure (REE) and total lean mass (TLM) in the SCI, SB, CTRL, and OW groups. METHODS: Two hundred fifteen subjects, including 85 CTRL, 31 OW, 33 SCI, and 66 SB, were evaluated. Body composition was estimated by dual energy x-ray absorptiometry (DXA). Measurements included height, weight, total lean mass (TLM), fat tissue mass (FTM), body mass index (BMI), BMI percentile (BMI%tile), and % fat. Resting energy measurements were obtained in fasting subjects with an open-circuit indirect calorimeter. RESULTS: There were gender differences in height, weight, BMI, TLM, fat mass, % fat, and REE. The REE in the SCI and SB groups was significantly different from that in the CTRL and OW groups, but no significant difference was found between the SCI and SB groups. The SB group had significantly higher REE/TLM ratios than did the other groups. The % fat was significantly higher in the SB and OW groups as compared to the CTRL and SCI groups. TLM was significantly higher in CTRL and OW groups as compared to SCI and SB groups, with the lowest TLM found in the SB group. CONCLUSION: Patients aged 11 to 21 years with SB or SCI have significant lean tissue mass deficits by DXA as compared to able-bodied CTRL and OW groups, with the greatest deficits in total lean mass measured in SB. The absolute REE values were significantly reduced in both SCI and SB groups in association with their lean tissue deficits. Interestingly, REE/TLM ratios were remarkably constant in the CTRL, OW, and SCI groups but significantly elevated in the SB group. One would expect an even greater degree of adiposity in the SB group if their REE/TLM ratios were not elevated relative to those without congenital paralysis.

Frequency of hypoglycaemia during the intravenous glucose tolerance test in overweight children.

The study aimed to assess the frequency of hypoglycaemia during the insulin-modified, frequently sampled intravenous glucose tolerance test (FSIVGTT) in overweight Hispanic children. The study included 210 children, mean age=11+/-1.7 years, BMI percentile=97.2+/-2.9 who where enrolled in a longitudinal study to explore risk factors for type 2 diabetes. Two fasting blood samples were collected to determine basal glucose and insulin concentrations. At time 0, glucose (0.3 g/kg body weight) was administered intravenously. Eleven blood samples were collected until 180 min post glucose injection. Insulin (0.02 U/kg body weight) was injected intravenously at 20 min. Plasma was analyzed for glucose and insulin and used for the determination of insulin sensitivity. Hypoglycaemia, defined as a plasma glucose<50 mg/dl, was observed in one asymptomatic subject (<0.5% subjects). In addition, only 1.9% of subjects (n=4) had plasma glucose<60 mg/dl at any time during the FSIVGTT. The frequency of hypoglycaemia during the insulin modified FSIVGTT is very low in overweight Hispanic youth.

Lower birth weight associated with current overweight status is related with the metabolic syndrome in obese Japanese children.

The purpose of this study was to clarify the relationship between lower birth weight and current overweight status and to examine the involvement of these factors in the development of the metabolic syndrome (MS) in obese Japanese children. We examined 97 obese boys (mean age 11.3 years; mean percentage overweight [POW] 52.4%) and 29 obese girls (mean age 11.1 years; mean POW 58.3%). The anthropometric measurements, blood pressure, fasting serum insulin and blood glucose, liver enzymes, lipids and lipoproteins were measured. Birth weight and gestational weeks were also recorded. The subjects were divided into either an MS group or a Non-MS group using criteria proposed for Japanese children. We compared the weight parameters (birth weight, current weight and current weight-to-birth weight ratio [WBWR]) between the two groups and analyzed the relationships between the weight parameters and metabolic derangements. There were no significant differences in age or anthropometric measurements between the two groups. However, birth weight in the MS group was lower than that in the Non-MS group, while WBWR of the MS group was higher than that in the Non-MS group. Blood pressure and serum insulin correlated positively with WBWR. These findings suggested that lower birth weight with current overweight status was associated with the MS in obese Japanese children. We were unable to clarify whether subjects with lower birth weight who achieved proper weight gains had the same risk as subjects with appropriate birth weight. However, they should be assisted to grow adequately to prevent future metabolic derangements.

Obesity is associated with increased serum TSH level, independent of thyroid function.

OBJECTIVE: To reinvestigate the relationship between circulating TSH levels and adiposity in a cohort of obese people, who have normal thyroid function. METHODS: Retrospective cross-sectional analysis was carried out on 226 euthyroid obese or overweight female patients. Thirty-nine female lean and euthyroid subjects (BMI<25 kg/m2) were included in the study group. TSH, free thyroxine (FT4), free triiodothyronine (FT3), fasting plasma levels of insulin and glucose, homeostasis model assessment (HOMA) for insulin resistance (HOMA-IR) and insulin secretion (HOMA-b cell), body weight, height, body mass index (BMI) and waist circumference were assessed. RESULTS: Serum TSH levels were higher in the obese than in the lean subjects. In the study group (lean and obese subjects), there was a significant positive correlation between serum TSH and body weight (r=0.231, p<0.001), BMI (r=0.270, p<0.001), waist circumference (r=0.219, p=0.001), fasting insulin (r=0.201, p=0.002) and HOMA-IR (r=0.201, p=0.002); there was no correlation between serum FT4 and any of the parameters. A multivariate linear regression analysis revealed that only BMI (p=0.012, 95% CI=0.01-0.08) contributed significantly to the variance of TSH. CONCLUSIONS: This study strongly supports existing, but contradictory evidence that serum TSH levels are positively correlated with the degree of obesity and some of its metabolic consequences in overweight people with normal thyroid function.

Hormonal levels of leptin, insulin, ghrelin, and neuropeptide Y in lean, overweight, and obese Saudi females.

OBJECTIVE: To studied the relationship that exists between leptin, ghrelin, insulin, neuropeptide Y (NPY), anthropometric, and metabolic variables in Saudi females. METHODS: The study was conducted at the Department of Genetics, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia from November 2004 to August 2005. One hundred and twenty-two Saudi females were divided into 3 body mass index (BMI) groups: lean (N=60), overweight (N=17), and obese (N=45). Fasting leptin, ghrelin, insulin, NPY and glucose concentrations were determined. RESULTS: Leptin levels in overweight and obese groups were significantly higher than those in lean group. Leptin levels showed a positive correlation with BMI in obese (0.81), overweight (0.78), and lean (0.48). In contrast, ghrelin concentration decreased in obese and overweight subjects compared to lean subjects. Ghrelin levels were negatively correlated with BMI in obese (-0.81), overweight (-0.58), and lean subjects (-0.62). Negative correlations were found between serum insulin and ghrelin concentrations in lean and obese subjects. Glucose and insulin levels were significantly higher in the obese group compared to controls. No differences were found in serum NPY between the 3 groups. CONCLUSION: Leptin levels increased remarkably with increasing BMI. A leptin resistance state seems to exist in many obese and overweight individuals. Ghrelin concentration was decreased in overweight and obese subjects. These data demonstrate a significant inverse relationship between ghrelin and leptin levels in overweight and obese subjects.

Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage.

Orlistat, in the 60-mg over-the-counter dose, was recently approved by the FDA. This lipase inhibitor blocks absorption of ~25% of ingested fat and has ~85% of the efficacy of the 120-mg dose for weight loss. Over 16 weeks weight loss with diet and orlistat 60 mg averages ~5% of initial body weight. The 60-mg dose is better tolerated than the 120-mg dose and the gastrointestinal side effects are minimal when individuals consume < 30% of their energy from fat. In addition to facilitating modest weight loss, orlistat use decreases serum LDL-cholesterol values by ~10%. When taken three times daily before meals, orlistat 60 mg modifies lifestyle behavior, encourages lower fat-consumption and sets the stage for other healthy lifestyle changes.

High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women.

BACKGROUND: An association between high prepregnant body mass index (BMI) and early termination of breastfeeding has been observed, but this finding may have depended on the sociocultural context. OBJECTIVE: The objective was to determine whether this association was stronger with increasing maternal obesity, was modified by gestational weight gain, and still existed when there was greater social support for breastfeeding. DESIGN: Study participants (37 459 women) were drawn from the Danish National Birth Cohort. The association of prepregnant BMI and gestational weight gain with the termination of full or any breastfeeding by 1, 16, or 20 wk postpartum was assessed with logistic regression analyses, and the risk of early termination of full and any breastfeeding during the first 18 mo postpartum was assessed with Poisson regression analyses. RESULTS: The risk of early termination of any (with similar results for full) breastfeeding rose progressively with increasing prepregnant BMI values (in kg/m(2)), from 1.12 (95% CI: 1.09, 1.16) for overweight (BMI = 25.0-29.9) women to 1.39 (95% CI: 1.19, 1.63) for obese class III women (BMI >or= 40) compared with normal-BMI women. Gestational weight gain did not add to or modify the association between prepregnant BMI and breastfeeding. CONCLUSIONS: These findings extend the observation to a broader range of BMIs that the greater the prepregnant BMI, the earlier the termination of breastfeeding. Together with the fact that this association was evident in a more supportive social context for breastfeeding, these findings suggest a biological basis for the association.

Moderate exercise and bright light treatment in overweight and obese individuals.

OBJECTIVE: Increased physical activity is important given the concern over the growing rates of obesity. The aim of this study is to conduct a controlled investigation of the effects of bright light therapy and exercise on weight loss and body composition in overweight and obese individuals. RESEARCH METHODS AND PROCEDURES: Twenty-five overweight and obese subjects were assigned to 6 weeks of moderate exercise with or without bright light treatment. Outcome measure included changes in body mass and body composition and ratings of mood, seasonality, and sleep. RESULTS: Body weight decreased significantly with exercise in subjects in the light and non-light treatment groups, but the change was not significantly different between the groups. Similar results were found for BMI. With exercise, body fat decreased significantly only in the light treatment group. There was a significant effect of the interaction of group by time on body fat composition, but the group by time interaction failed to reach statistical significance for body weight and BMI. Mood scores improved significantly with exercise in the light group, but no significant changes were noted regarding sleep. DISCUSSION: This preliminary study is the first to show that addition of bright light treatment to a 6-week moderate exercise program can alter body composition by significantly reducing body fat. The reduction in body fat mass is of particular importance, because visceral fat has been particularly implicated as a major factor in the development of the metabolic syndrome. This study is an important step toward finding ways to maximize the effects of exercise.

Weekend and weekday patterns of physical activity in overweight and normal-weight adolescent girls.

OBJECTIVE: To describe the patterns (specifically comparing weekdays and weekends classified by intensities) of physical activity (PA) measured by accelerometry in adolescent girls. RESEARCH METHODS AND PROCEDURES: Healthy sixth grade girls (n=1603), 11 to 12 years old, were randomly recruited from 36 schools participating in the Trial of Activity in Adolescent Girls. Age, ethnicity, socioeconomic status, weight, and height were taken. PA patterns were measured for 6 days using accelerometry. RESULTS: Adolescent girls spend most of their time in sedentary (52% to 57% of the day) and light activity (40% to 45% of the day) on weekdays and weekends. In all girls, total PA comprised 44.5% of the day (41.7% light, 2.2% moderate, and 0.7% vigorous) with sedentary activity comprising 55.4%. Moderate-to-vigorous PA (MVPA) was higher (p<0.001) on weekdays than weekends in all girls, but MVPA was lower in at-risk of overweight+overweight girls (p<0.001) on both weekdays and weekends compared with normal-weight girls. DISCUSSION: Adolescent girls are more active at moderate and vigorous intensities on weekdays than on weekends, and at-risk of overweight and those overweight spend less time engaging in MVPA than normal-weight girls.