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1.
Obesity (Silver Spring) ; 28(6): 1149-1156, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32379398

RESUMO

OBJECTIVE: People with diabetes show great variability in weight gain and duration of obesity at the time of diagnosis. BMI trajectories and other cardiometabolic risk factors prior to type 2 diabetes were investigated. METHODS: A total of 6,223 participants from the Rotterdam Study cohort were included. BMI patterns before diagnosis of diabetes were identified through latent class trajectories. RESULTS: During a mean follow-up of 13.7 years, 565 participants developed type 2 diabetes. Three distinct trajectories of BMI were identified, including the "progressive overweight" group (n = 481, 85.1%), "progressive weight loss" group (n = 59, 10.4%), and "persistently high BMI" group (n = 25, 4.4%). The majority, the progressive overweight group, was characterized by a steady increase of BMI in the overweight range 10 years before diabetes diagnosis. The progressive weight loss group had fluctuations of glucose and marked beta cell function loss. The persistently high BMI group was characterized by a slight increase in insulin levels and sharp increase of insulin resistance accompanied by a rapid decrease of beta cell function. CONCLUSIONS: Heterogeneity of BMI changes prior to type 2 diabetes was found in a middle-aged and elderly white population. Prevention strategies should be tailored rather than focusing only on high-risk individuals.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etiologia , Obesidade/classificação , Sobrepeso/classificação , Adulto , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Fatores de Risco , Ganho de Peso , Perda de Peso
2.
JAMA Netw Open ; 3(4): e202012, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32239222

RESUMO

Importance: Prior studies have identified an association between obesity and prescription opioid use in the US. However, the pain conditions that are factors in this association remain unestablished. Objective: To investigate the association between obesity and pain diagnoses recorded by primary care clinicians as reasons for prescription of opioids. Design, Setting, and Participants: A cross-sectional study including 565 930 patients aged 35 to 64 years with a body mass index (BMI) measurement recorded in 2016 was conducted. Electronic health records of patients seen by primary care clinicians in the US in the multipayer athenahealth network from January 1, 2015, to December 31, 2017, were reviewed, and data were analyzed from March 1 to September 15, 2019. Main Outcomes and Measures: Any prescription of opioids in the 365 days before or after the first BMI measurement in 2016 were identified. All International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, claims within 7 days before each opioid prescription were captured and classified using a pain diagnosis typologic system. Weight was categorized as underweight (BMI, 18.5-19.9), normal weight (BMI, 20.0-24.9), overweight (BMI, 25.0-29.9), obese I (BMI, 30-34.9), obese II (BMI, 35.0-39.9), obese III (BMI, 40.0-49.9), and obese IV (BMI, 50.0-80.0). Results: Among 565 930 patients, 329 083 (58.1%) were women. A total of 125 093 patients (22.1%) were aged 35 to 44 years, 199 384 patients (35.2%) were 45 to 54 years, and 241 453 patients (42.7%) were 55 to 64 years. A total of 177 631 patients (31.4%) were overweight and 273 135 patients (48.2%) were obese at baseline. Over 2 years, 93 954 patients (16.6%) were prescribed opioids. The risk of receiving prescription opioids increased progressively with BMI (adjusted relative risk for overweight: 1.08; 95% CI, 1.06-1.10; obese I: 1.24; 95% CI, 1.22-1.26; obese II: 1.33; 95% CI, 1.30-1.36; obese III: 1.48; 95% CI, 1.45-1.51; and obese IV, 1.71; 95% CI, 1.65-1.77). The percentage of patients with opioid prescriptions attributable to an overweight or obese BMI was 16.2% (95% CI, 15.0%-17.4%). Prescription opioids for management of osteoarthritis (relative risk for obese vs normal weight, 1.90; 95% CI, 1.77-2.05) and other joint disorders (relative risk, 1.63; 95% CI, 1.55-1.72) both had stronger associations with obesity than the mean for any pain diagnosis (relative risk, 1.33; 95% CI, 1.31-1.36). Osteoarthritis, other joint disorders, and other back disorders comprised a combined 53.4% of the absolute difference in prescription of opioids by obesity. Conclusions and Relevance: Joint and back disorders appear to be the most important diagnoses in explaining the increased receipt of opioid prescriptions among patients with obesity. Addressing the opioid crisis will require attention to underlying sources of demand for prescription opioids, including obesity, through its associations with pain.


Assuntos
Analgésicos Opioides/efeitos adversos , Obesidade/complicações , Dor/tratamento farmacológico , Prescrições/estatística & dados numéricos , Adulto , Analgésicos Opioides/uso terapêutico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/epidemiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Artropatias/tratamento farmacológico , Artropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Obesidade/epidemiologia , Osteoartrite/tratamento farmacológico , Osteoartrite/epidemiologia , Dor/etiologia , Atenção Primária à Saúde/normas , Risco , Estados Unidos/epidemiologia
3.
Phys Ther ; 100(6): 963-978, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32211862

RESUMO

BACKGROUND: Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease. PURPOSE: The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity. DATA SOURCES: Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017. STUDY SELECTION: This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article. DATA EXTRACTION: Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached. DATA SYNTHESIS: Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias. LIMITATIONS: The large variability of outcomes and interventions made comparisons difficult. CONCLUSIONS: A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.


Assuntos
Terapia por Exercício/métodos , Obesidade/reabilitação , Aptidão Física , Treinamento de Resistência , Adulto , Idoso , Índice de Massa Corporal , Terapia Combinada , Aconselhamento , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Obesidade/classificação , Obesidade/dietoterapia , Obesidade/fisiopatologia , Consumo de Oxigênio , Resistência Física , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Velocidade de Caminhada
4.
Can J Surg ; 63(2): E142-E149, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32216250

RESUMO

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in primary hip and knee arthroplasty for patients with increased body mass index (BMI) and those with normal BMI, using data from the registry of the Alberta Bone and Joint Health Institute (ABJHI). Methods: We retrospectively reviewed the data compiled in the ABJHI registry between March 2010 and July 2016. We reviewed outcomes with respect to length of stay, discharge destination, 30-day readmission, postoperative infection, postoperative transfusion requirements, postoperative adverse events and in-hospital postoperative mechanical complications. Results: A total of 10 902 patients (6076 women, 4826 men) who underwent THA and 16 485 patients (10 057 women, 6428 men) who underwent TKA were included in the study. For both THA and TKA, patients with increased BMI had an increased number of in-hospital medical events, had an increased rate of deep infection, were less likely to be discharged home (p < 0.001) and had decreased transfusion requirements (p < 0.001) than patients whose weight was in the normal range. Increased BMI increased the rate of 30-day readmission and length of stay in the THA cohort but not in the TKA cohort. Increased BMI had no effect on acute postoperative dislocation or periprosthetic fractures. Patients with a BMI of 30 kg/m2 or greater required a THA 1.7 years earlier than patients of normal weight, patients whose BMI was 35 kg/m2 or greater required a THA 3.4 years earlier, and patients whose BMI was 40 kg/m2 or greater required a THA 5.8 years earlier. In the TKA cohort, patients with a BMI of 30 kg/m2 or greater required a TKA 2.7 years earlier than patients whose weight was in the normal range, patients with a BMI of 35 kg/m2 or greater required a TKA 4.6 years earlier, and patients whose BMI was 40 kg/m2 or greater required a TKA 7.6 years earlier. Conclusion: Our study quantifies the effects of obesity in primary hip and knee arthroplasty. It provides a greater understanding of the risks in the obese population when contemplating joint arthroplasty.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Índice de Massa Corporal , Obesidade/epidemiologia , Idoso , Alberta/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Cuidados Semi-Intensivos/estatística & dados numéricos
5.
Obesity (Silver Spring) ; 28(3): 484-492, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32090513

RESUMO

OBJECTIVE: Obesity is responsible for a huge burden of suffering and social costs, and yet many patients lack access to evidence-based therapies. The diagnostic term "obesity" and inadequate International Classification of Diseases(ICD) codes contribute to suboptimal efforts to prevent and treat obesity as a chronic disease. The goal of this review is to develop a medically actionable classification system based on the diagnostic term "adiposity-based chronic disease" (ABCD) that reflects disease pathophysiology and specific complications causing morbidity and mortality. METHODS: A coding system based on the diagnosis of ABCD with four domains is proposed: A codes reflect pathophysiology, B codes indicate BMI classification, C codes specify specific biomechanical and cardiovascular complications remediable by weight loss, and D codes indicate the degree of the severity of complications. Supplemental codes identify aggravating factors that complicate care and that are relevant to a personalized therapeutic plan. RESULTS: The coding system addresses pathophysiology and therapeutic goals and differential risk, presence, and severity of specific complications that are integral to ABCD as a chronic disease. CONCLUSIONS: The scientifically correct and medically actionable approach to diagnosis and disease coding will lead to greater acknowledgement of ABCD as a disease and accessibility to evidence-based therapies on behalf of patients across the life cycle.


Assuntos
Obesidade/classificação , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade
6.
Obesity (Silver Spring) ; 28(2): 353-361, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31905265

RESUMO

OBJECTIVE: Differences in discriminative and predictive ability for all-cause mortality of two clinical staging systems, the Edmonton Obesity Staging System (EOSS) and Cardiometabolic Disease Staging (CMDS), were estimated. METHODS: Data for nonpregnant persons aged 40 to 75 years were extracted from the National Health and Nutrition Examination Survey. Predictive and discriminative ability was assessed using pseudo-R2 and C-statistics. Median years of life lost were also computed for each score. RESULTS: Differences in out-of-sample estimates of pseudo-R2 and C-statistics (EOSS model as reference) were 0.02 (95% CI: 0.01-0.04) (Kent pseudo-R2 ), 0.03 (0.01-0.04) (Royston pseudo-R2 ), and 0.02 (0.01-0.02) (C-statistics). The median years of life lost for EOSS scores 2 and 3 (low to high risk) for a reference person were 1.19 and 6.76 years. Those for CMDS scores 1, 2, 3, and 4 (low to high risk) were 1.53, 2.90, 3.91, and 8.51 years. Consistent results from the in-sample estimates were observed. CONCLUSIONS: CMDS had statistically significantly greater predictive and discriminative ability than EOSS for persons aged 40 to 75. While the clinical relevance of these differences is unknown, CMDS may have greater clinical utility given that it uses fewer items to risk stratify. The clinical relevance and utility need to be studied further.


Assuntos
Inquéritos Nutricionais/métodos , Obesidade/classificação , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/mortalidade , Taxa de Sobrevida
8.
Nutr. hosp ; 36(5): 1087-1094, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184631

RESUMO

Objetivos: analizar la prevalencia de salud metabólica en pacientes obesos de Mallorca. Métodos: los participantes se clasificaron en obesos sanos metabólicamente (OSM) y obesos no sanos metabólicamente (ONSM) en función de si presentaban o no síndrome metabólico (SMet), definido según los criterios del NCEP ATP III. Se evaluaron hábitos alimentarios, tóxicos y estilo de vida, tiempo de evolución de la obesidad, antecedentes de lactancia materna, obesidad en la infancia y familiares de obesidad y diabetes mellitus, así como glucosa, colesterol total, colesterol-HDL y triglicéridos plasmáticos en 457 pacientes obesos residentes en Mallorca. Resultados: la prevalencia de OSM fue del 49,2% y la de ONSM fue del 50,8%. El fenotipo de OSM disminuyó con la edad. Todos los pacientes presentaron hábitos inadecuados. Ambos grupos presentaron similar consumo de frutas, ensaladas y verduras, hábito tabáquico y práctica de actividad física. El 37,4% de los sujetos consumía bebidas azucaradas y el 52,9% consumía alcohol, más en ONSM (4,3%) que en OSM (0,4%). Los sujetos ONSM presentaron mayores valores de índice de masa corporal (IMC), circunferencia abdominal, porcentaje de grasa e índice de grasa visceral (IGV) y variables metabólicas estudiadas que los OSM. Conclusiones: más de la mitad de la población obesa analizada presentó complicaciones metabólicas, aunque toda la población obesa mostró similares hábitos alimentarios y de estilo de vida inadecuados. El incremento de edad, el bajo nivel educativo, los años de evolución de la obesidad y la localización visceral de la grasa se asocian a un estado metabólico no saludable. Deberían aunarse criterios para definir y tipificar el estado metabólico de los sujetos obesos


Aims: to assess the prevalence of metabolic health in Mallorca obese patients. Methods: participants were classified in metabolically healthy obese (MHO) and metabolically non-healthy obese (MNHO). Food, toxic and lifestyle habits, time of obesity evolution, breastfeeding, obesity in childhood and family history of obesity and diabetes mellitus, as well as glycemia, total cholesterol, HDL-cholesterol and triglyceridemia were evaluated in 457 obese patients. Results: prevalence of MHO was 49.2% and that of MNHO was 50.8%. MHO phenotype decreased with age. All patients showed inadequate habits. Consumption of fruits, salads and vegetables, tobacco and physical activity were similar between both groups; 37.4% of patients consumed sugary sweet drinks, and 52.9% consumed alcohol, higher in MNHO (4.3%) than in MHO (0.4%). MNHO showed higher values of BMI, abdominal circumference, fat percentage and visceral fatty index, as well as all metabolically studied outcomes. Conclusions: more than half of assessed obese population showed metabolic complications, but all obese population showed similar inadequate food and lifestyle habits. Increase of age, low educational level, years of obesity evolution, and visceral localization of fat are associated with a metabolically non-healthy status. Criteria to define and typify the metabolic state of obese subjects should be unified


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Espanha/epidemiologia , Obesidade/classificação , Comportamento Alimentar , Atividade Motora , Índice de Massa Corporal , Estilo de Vida , Inquéritos Nutricionais , Antropometria , Estudos Transversais
9.
Nutr Hosp ; 36(5): 1095-1100, 2019 Oct 17.
Artigo em Espanhol | MEDLINE | ID: mdl-31516010

RESUMO

Introduction: Introduction: in Mexico the main problem in public health is obesity and other diseases that are associated whit this condition, including oral health. Objective: to evaluate the effect of metformin treatment in patients with class I obese on the activity of metalloproteinases present in periodontium with chronic periodontitis. Methods: a clinical study was conducted in 68 patients with class I obesity and periodontal disease. They were divided into 4 groups. 2 of them, in addition to the periodontal treatment, were administered metformin 850 mg per day for six weeks; 2 samples were taken per patient of periodontal tissue before and after each treatment, body mass index, plaque index and inflammation were measured. Acrylamide gel zymography was used to measure the activity of metalloproteinases in the sample of tissue collected. The data obtained were analyzed by descriptive statistics, student t for related samples and one-way ANOVA was performed considering p < 0.01 as statistically significant. Results: in the group of patients who were administered metformin at the end of the treatment, there was a decrease in the body mass index, the degree of inflammation and lower metalloproteinase activity, compared with the control group (65% vs 25%; < 0.01). Conclusions: treatment with metformin in patients with obesity class I and periodontal disease decreases BMI, improves the symptoms of chronic periodontitis and decreases the activity of metalloproteinases 1, 3, 8, V present in periodontium of these patients.


Assuntos
Periodontite Crônica/complicações , Periodontite Crônica/enzimologia , Hipoglicemiantes/uso terapêutico , Metaloproteases/efeitos dos fármacos , Metaloproteases/metabolismo , Metformina/uso terapêutico , Obesidade/complicações , Obesidade/tratamento farmacológico , Adulto , Feminino , Humanos , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Obesidade/classificação
11.
Diabetes Metab Syndr ; 13(4): 2419-2424, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405653

RESUMO

AIMS: To investigate the association of obesity phenotypes with non-obese components of metabolic syndrome (MetS) by considering the presence of general adiposity and central obesity. METHODS: We analyzed the data of population-based cross-sectional study of 981 adults' individuals who were community dwelling in urban population of Babol, the north of Iran. The demographic characteristics and anthropometric measures and hypertension were collected with standard method by trained nurses. The fasting blood sugar, CHL, TG, HDL-C and LDL-C were measured by enzymatic method. The presence of cardiometabolic risk factors were analyzed according to the combination of obesity phenotypes either overweight/obese or central obese. The logistic regression model was used to calculate the adjusted odds ratio (OR) of obesity phenotypes in compared with normal weight not central obese in association of presence of metabolic abnormality. RESULTS: The 394 (40.6%) individuals were both overweight/obese and central obese and 295 (30.1%) persons were "normal weight not central obese" and the minority 28(2.9%) were normal weight but central obese and the remainder 260 (26.5%) were "overweight/obese not central obese". Overweight/obese not central obese increased significantly the odds of presence of ≥2 non-obese components of metabolic abnormality by 2.17 times (95%CI OR: 1.51, 3.13) but the OR was elevated for the joint phenotypes of overweight/obese and central obese (OR = 4.16 (95%CI: 2.85, 6.06) as compare with normal weight not central obese. CONCLUSIONS: Overweight/obese alone increased the risk of cardiometabolic abnormality but being overweight/obese and central obese a further elevated the risk compared with "normal weight not central obese".


Assuntos
Adiposidade , Hipertensão/fisiopatologia , Síndrome Metabólica/epidemiologia , Obesidade/classificação , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Adulto , Biomarcadores/análise , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico
12.
Diabetes Metab Syndr ; 13(5): 2897-2905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31425954

RESUMO

BACKGROUND AND OBJECTIVE: Although obesity is a heterogeneous disease, little is known regarding chronic medical conditions (CMCs) that defines variability in obese populations. The characterization of obese populations using CMCs rather than categorization using BMI alone can advance understanding of obesity. The aims of this study are to phenotype obesity in a large representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) obese adults using CMCs, and assess relationship between resulting phenotypes and self-rated health (SRH). METHODS: Sex-specific two-step cluster analysis was used to phenotype obese participants (n = 12,547) to CMC-based clusters. The prevalence of CMCs and lifestyle risk factors in each cluster was assessed. Sex and race/ethnic specific association between cluster membership and SRH was determined using odds ratio (OR) from logistic regression analysis. RESULTS: Distinct subgroups of obese men and women were observed: moderate dyslipidemic healthy young obese men, hypertensive-dyslipidemic middle-age obese men, hypertensive young obese men, hypertensive-dyslipidemic-asthmatic middle-age obese men, and syndemic elderly obese men, healthy young obese women, hypertensive-dyslipidemic middle-age obese women, dyslipidemic young adult obese women, syndemic middle-age obese women, and syndemic elderly obese women. Participants in the more CMCs symptomatic clusters reported high rates of behavioral risk factors and showed significantly greater odds of poor SRH than participants in the less symptomatic clusters. Compared to obese persons who are asymptomatic for CMCs, syndemic elderly obese and women men had much higher increased ORs for poor SRH with values of 3.88 [95% CI = 2.41-6.26], 3.96 [95% CI = 1.86-8.30] and 7.25 [95% CI = 2.41-9.6] for NHW, NHB and MA men, respectively. The corresponding ORs for women are 4.08 [95% CI = 2.71-6.14], 4.01 [95% CI = 2.40-6.69], and 2.62 [95% CI = 1.32-5.19], respectively. CONCLUSION: Obesity treatment and intervention should consider heterogeneity within obese persons and pay greater attention to obesity related co-morbidities and metabolic manifestations.


Assuntos
Doença Crônica/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Obesidade/classificação , Obesidade/fisiopatologia , Fenótipo , Adulto , Idoso , Artrite/epidemiologia , Asma/epidemiologia , Análise por Conglomerados , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Seguimentos , Cardiopatias/epidemiologia , Humanos , Hipertensão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
13.
PLoS One ; 14(7): e0219123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276537

RESUMO

BACKGROUND: Numerous studies have demonstrated that different weight change patterns from adolescence to adulthood may exert different effects on opportunities from which individuals subsequently benefit. OBJECTIVES: This study aimed to investigate the association of weight change patterns from late adolescence to young adulthood with monthly wage in young adulthood for both genders in Taiwan. METHODS: A nationally representative retrospective panel of 3730 young people (1707 men and 2023 women) from the Taiwan Educational Panel Survey (2001-2014) was included. Individuals were divided into four weight-change-pattern categories based on changes in their body mass index at two time points that were 7 years apart, between late adolescence (aged 18-19 years) and young adulthood (aged 25-26 years). These categories were (1) no obesity, (2) obesity reversal, (3) developing obesity, and (4) persistent obesity. Cross-classified, hierarchical linear regression modeling analysis was performed to explore the association of weight change patterns with monthly wage in young adulthood, after adjustment for both individual- and contextual-level variables. RESULTS: Of the weight-change-pattern categories for both genders, individuals with persistent obesity had the lowest monthly wage. For women, the mean monthly wage decreased progressively for the categories of no obesity, obesity reversal, developing obesity, and persistent obesity (test for difference, P = 0.016; test for trend, P = 0.026). Women with persistent obesity earned 20% less per month than did those who were never obese (P = 0.024), after controlling for individual and contextual factors. For men, no association was found between weight change patterns and monthly wage. CONCLUSION: Persistent obesity from late adolescence to young adulthood is associated with low monthly wage in young adulthood in women but not in men. These findings highlight the urgency of addressing persistent obesity early in life, especially for women.


Assuntos
Obesidade/epidemiologia , Salários e Benefícios , Adolescente , Saúde do Adolescente , Adulto , Índice de Massa Corporal , Peso Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Análise Multinível , Obesidade/classificação , Estudos Retrospectivos , Caracteres Sexuais , Taiwan , Adulto Jovem
14.
Obes Facts ; 12(2): 131-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844811

RESUMO

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO's proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.


Assuntos
Técnicas de Diagnóstico Endócrino/normas , Obesidade/classificação , Obesidade/diagnóstico , Adiposidade , Pesquisa Biomédica/normas , Pesquisa Biomédica/tendências , Índice de Massa Corporal , Doença Crônica , Técnicas de Diagnóstico Endócrino/tendências , Humanos , Obesidade/epidemiologia , Obesidade/etiologia , Sociedades Científicas/normas , Terminologia como Assunto
15.
Intensive Care Med ; 45(6): 757-769, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30888440

RESUMO

The World Health Organization defines overweight and obesity as the condition where excess or abnormal fat accumulation increases risks to health. The prevalence of obesity is increasing worldwide and is around 20% in ICU patients. Adipose tissue is highly metabolically active, and especially visceral adipose tissue has a deleterious adipocyte secretory profile resulting in insulin resistance and a chronic low-grade inflammatory and procoagulant state. Obesity is strongly linked with chronic diseases such as type 2 diabetes, hypertension, cardiovascular diseases, dyslipidemia, non-alcoholic fatty liver disease, chronic kidney disease, obstructive sleep apnea and hypoventilation syndrome, mood disorders and physical disabilities. In hospitalized and ICU patients and in patients with chronic illnesses, a J-shaped relationship between BMI and mortality has been demonstrated, with overweight and moderate obesity being protective compared with a normal BMI or more severe obesity (the still debated and incompletely understood "obesity paradox"). Despite this protective effect regarding mortality, in the setting of critical illness morbidity is adversely affected with increased risk of respiratory and cardiovascular complications, requiring adapted management. Obesity is associated with increased risk of AKI and infection, may require adapted drug dosing and nutrition and is associated with diagnostic and logistic challenges. In addition, negative attitudes toward obese patients (the social stigma of obesity) affect both health care workers and patients.


Assuntos
Obesidade/classificação , Índice de Massa Corporal , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Saúde Global/estatística & dados numéricos , Humanos , Obesidade/epidemiologia , Obesidade/fisiopatologia , Prevalência , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Organização Mundial da Saúde/organização & administração
16.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 45(2): 101-108, mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188058

RESUMO

INTRODUCCIÓN: El sobrepeso y la obesidad tienen rasgos epidémicos a nivel mundial, siendo por tanto un problema de salud pública. La clasificación tradicional con el índice de masa corporal es un buen inicio, pero luego de la evidencia de las actividades bioquímicas del tejido adiposo, su medida es una necesidad. Existen múltiples fórmulas para tal fin, pero con poca posibilidad de aplicación en atención primaria. Proponemos las siguientes fórmulas para su utilización con este fin. Hombres = ([IMC/PA]*10) +IMC. Mujeres = ([IMC/PA]*10) + IMC+10. MATERIAL Y MÉTODOS: Trabajo descriptivo, prospectivo. Se incluyeron 505 mujeres, 489 hombres, con edades entre 30 y 90 años. Se midió el peso, la talla y el perímetro abdominal, siendo calculado índice de masa corporal, porcentaje de grasa con CUN BAE y fórmulas propuestas. Resultados: Se realizaron cálculos comparativos entre CUN BAE y fórmulas a validar: en valores descriptivos no se evidenció diferencia significativa. Mujeres chi2 = 1,1; p = 0,89. Hombres chi2 = 0,8; p = 0,93. El intervalo de confianza y error estándar fueron p = 1. La correlación numérica evidencia r = 0,94; p = 0,0001; R2 = 0,89. El error relativo de la media es en hombre 5,48% y mujeres (-0,43%). La comparación de medianas demostró Wilcoxon=0,8333. El estudio de sensibilidad y especificidad para puntos de corte demuestra por curva ROC AUC = 0,986; p = < 0,0001. CONCLUSIONES: La falta de diferencia significativa entre los resultados de ambas fórmulas hace posible su propuesta para el cálculo del porcentaje graso en el peso corporal en consulta de atención primaria


INTRODUCTION: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men = (body mass index [BMI/Abdominal Circumference [AC]*10) + BMI. Women = ([BMI/AC]*10) + BMI + 10. MATERIAL AND METHODS: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated. RESULTS: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women chi2 = 1.1; P = .89. Men chi2 = 0.8; P = .93. The confidence interval and standard error p = 1. The numerical correlation shows r = 0.94; p = 0.0001; R2 = 0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon = 0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC = 0.986; P = < .0001. CONCLUSIONS: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tecido Adiposo , Índice de Massa Corporal , Circunferência da Cintura , Obesidade/classificação , Obesidade/diagnóstico , Sobrepeso/classificação , Sobrepeso/diagnóstico , Estudos Prospectivos
17.
Diabetes Metab Syndr ; 13(1): 62-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641777

RESUMO

Insulin resistance (IR) is the corner stone of metabolic obesity. This cross-sectional analytical study was aimed to find out the frequency of IR in non-diabetic adult individuals of different obesity phenotypes that would help to implement preventive measures to avoid the cardiometabolic catastrophes. METHODS: Total 955 nondiabetic adult individuals were selected and categorized into six metabolic phenotypes by metabolic syndrome criteria in each BMI group (18.5-24.9-normal weight, 25-29.9-overweight, ≥30-obese). From them, metabolically obese normal weight, metabolically obese overweight, metabolically healthy obese and metabolically unhealthy obese were selected as Obesity phenotypes (N = 616). RESULTS: The frequency of IR was found to be very high (60.2%) in total nondiabetic adult obese individuals (N = 616). Highest frequency of IR was found in MUO phenotype (76.3%), lowest frequency of IR was found in MONW phenotype (37.1%) and frequency of IR in MOOW and MHO phenotypes found to be identical but significantly (p < 0.0001) less than MUO and significantly (p < 0.0001) more than MONW phenotype. Among the obesity phenotypes, females were more insulin resistant than males (67.5% vs 48.1% respectively, p < 0.05). Frequency of IR found significantly (p < 0.05) more in female than male in all obesity phenotypes except in MUO phenotype where males found to show significantly (p < 0.05) higher frequency than females. Frequency of IR was significantly higher in younger (20-39 yrs) age group than 40-60 yrs age group (63.2% vs 53.5% respectively, p < 0.05). CONCLUSION: IR is alarmingly high (60.2%) in nondiabetic adult obese individuals. Among different obesity phenotypes, it is highest (76.3%) in MUO and lowest (37.1%) in MONW.


Assuntos
Resistência à Insulina , Síndrome Metabólica/etiologia , Obesidade/complicações , Adulto , Bangladesh/epidemiologia , Biomarcadores/análise , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/classificação , Fenótipo , Prognóstico , Adulto Jovem
18.
Clin Obes ; 9(1): e12287, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30458581

RESUMO

Health behaviour change is a cornerstone in the management of obesity, and data on health behaviours, intentions and barriers to change would be useful to inform the development of interventions. The aim of this study was to describe these variables in individuals with obesity, and to compare obesity classes. The study obtained data from the Canadian Community Health Survey 2011-2012 including 5614 adults with body mass index (BMI) ≥30 kg m-2 . The majority of participants reported eating four or more fruits and vegetables daily (65.3% [95% confidence interval {CI}: 64.1-66.6]), being a regular drinker (59.6% [95% CI: 58.4-61.0]) and inactive (58.0% [95% CI: 56.7-59.3]). About 84% of participants answered they should do and/or intend to do something in the next year to improve their health, with increasing exercise being the most reported choice (69.2% [95% CI: 67.1-71.5]). Among the 58.0% (95% CI: 55.9-60.2) of participants facing barriers to change, the lack of willpower was the most reported (37.0% [95% CI: 34.2-39.7]). No difference between classes for intention to change and barriers were found. Comorbidities were the most important factor explaining several health behaviours and barriers to change. The vast majority of participants, regardless of the severity of obesity, know they should do and also want to do something to improve their health, but faced a lack of willpower. Thus, the most important thing to consider during an obesity intervention is the lack of motivation to modify health behaviours and beyond BMI, the presence of comorbidities.


Assuntos
Terapia Comportamental/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Obesidade/psicologia , Obesidade/terapia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Canadá , Comorbidade , Dieta , Exercício Físico , Feminino , Frutas , Inquéritos Epidemiológicos , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Motivação , Obesidade/classificação , Verduras
19.
Obes Surg ; 29(1): 191-196, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30238216

RESUMO

BACKGROUND: The aim of the study was to assess the long-term outcome in terms of weight loss and remission of comorbidities among the patients who had undergone LSG in an Indian setting. METHODS: This is a retrospective observational study of patients (BMI > 30 kg/m2) who underwent LSG having a minimum 6 months of follow-up data. Based on preoperative BMI, patients were grouped as class 1, 30 < BMI < 35 kg/m2; class 2, 35 < BMI < 40 kg/m2; and class 3, BMI > 40 kg/m2. Data on BMI and %EWL between three classes and among genders at different follow-up points for 7 years were compared. RESULT: Study included 95 patients (mean age of 33.7 ± 11 years), and the preoperative mean BMI was 40.2 ± 5.1 kg/m2. At one year of surgery, 85.5% patients achieved > 50%EWL. The highest mean %EWL was found in class 1 (66.19%), followed by class 2 (56.73%) and class 3 (46.59%) at the sixth month follow-up. At the seventh year, %EWLs were 85.11% (class 1), 76.69% (class 2), and 62.98% (class 3) and the mean BMIs were 25.13 ± 3.09 kg/m2 (class 1), 26.86 ± 2.12 kg/m2 (class 2), and 31.07 ± 3.39 kg/m2 (class 3) and were significantly different (p < 0.05). At the last follow-up, though, the males showed slight weight regain; however, there were no statistical differences between the genders (p = 0.065). CONCLUSION: Outcome from LSG was better in patients with BMI < 40 kg/m2 compared to the patients with BMI > 40 kg/m2. Remission of obesity-related comorbidities was observed with LSG in all groups and gender did not influence the outcome significantly.


Assuntos
Gastrectomia , Obesidade/epidemiologia , Obesidade/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Índice de Massa Corporal , Comorbidade , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/estatística & dados numéricos , Humanos , Índia/epidemiologia , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Obesidade/etnologia , Obesidade Mórbida/classificação , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso , Adulto Jovem
20.
Semergen ; 45(2): 101-108, 2019 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-30268360

RESUMO

INTRODUCTION: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men=(body mass index [BMI/Abdominal Circumference [AC]*10)+BMI. Women=([BMI/AC]*10)+BMI+10. MATERIAL AND METHODS: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated. RESULTS: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women χ2=1.1; P=.89. Men χ2=0.8; P=.93. The confidence interval and standard error p=1. The numerical correlation shows r=0.94; p=0.0001; R2=0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon=0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC=0.986; P=<.0001. CONCLUSIONS: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics.


Assuntos
Tecido Adiposo , Índice de Massa Corporal , Circunferência da Cintura , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/classificação , Obesidade/diagnóstico , Sobrepeso/classificação , Sobrepeso/diagnóstico , Estudos Prospectivos
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