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1.
Top Spinal Cord Inj Rehabil ; 27(1): 23-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814881

RESUMO

Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.


Assuntos
Antropometria/métodos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/metabolismo , Obesidade/diagnóstico por imagem , Obesidade/metabolismo , Traumatismos da Medula Espinal/complicações , Fatores Etários , Humanos , Valor Preditivo dos Testes , Fatores Sexuais
2.
Int J Med Sci ; 18(8): 1768-1777, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33746594

RESUMO

Aim: In other respiratory infectious diseases, obesity may be associated with a poor outcome. For coronavirus disease 2019 (COVID-19), the association between obesity and severity or prognosis requires further analysis. Methods: This was a retrospective, single-center study. Hospitalized patients were recruited in Renmin Hospital of Wuhan University from January 2, 2020 to February 20, 2020. The data of body mass index (BMI) was obtained from follow-up of surviving patients. According to BMI, normal weight was defined as 18.5-23.9 kg/m2, overweight as 24.0-27.9 kg/m2 and obesity as > 28.0 kg/m2. Results: A total of 463 patients were enrolled, of which 242 (52.3%) patients were in the normal weight group; 179 (38.7%) were in the overweight group; and 42 (9.1%) were in the obesity group. Compared to the normal group, obese patients were more likely to have a higher heart rate; lower finger oxygen saturation; higher levels of white blood cells, neutrophil counts, basophil counts, intravenous glucose, triacylglycerol, uric acid, alanine aminotransferase, creatine kinase-MB, CD19+ cell counts and percentage; and lower levels of monocyte percentage, high density lipoprotein and CD3+ cell percentage. In addition, the proportions of hypertension (21.5% vs. 42.6%) and severe+critical illness (47.8 vs. 81.0 %) were significantly higher in the obesity group than those in normal group. However, no significant differences were observed between the normal and obesity groups in critical illness, organ damage and defined endpoint (mechanical ventilation or intensive care unit). Multiple logistic regression showed that obesity increased the risk of developing severe+critical illness (Odd ratio 3.586, 95% CI 1.550-8.298, P=0.003) in patients with COVID-19, and did not affect the risk of critical illness, organ damage and endpoints. Overweight did not affect the risk of severity, organ damage or endpoint in patients with COVID-19. Conclusion: Obesity may be a risk factor for developing severity in patients with COVID-19.


Assuntos
/complicações , Obesidade/complicações , Idoso , Contagem de Linfócito CD4 , /diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico por imagem , Radiografia Torácica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Am J Physiol Heart Circ Physiol ; 320(4): H1535-H1542, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33577436

RESUMO

This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese patients with heart failure with preserved ejection fraction (HFpEF), and related to decreased peak exercise oxygen uptake (peak V̇o2). LV strain and strain rate were measured by feature tracking of magnetic resonance cine images in 79 older obese patients with HFpEF (mean age: 66 yr; mean body mass index: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak V̇o2. LV circumferential early diastolic strain rate was impaired in HFpEF compared with controls (0.93 ± 0.05/s vs. 1.20 ± 0.07/s, P = 0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08 ± 0.03 vs. 0.13 ± 0.05, P < 0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak V̇o2 (R = 0.36, -0.27, and 0.35, respectively, all P < 0.01); this response, however, was almost entirely driven by E/e' itself, (R = -0.52, P < 0.001). Taken together, we found that although LV relaxation is impaired in older obese patients with HFpEF, and modestly correlates with their severely reduced peak exercise V̇o2, LV filling pressures appear to play a much more important role in determining exercise intolerance.NEW & NOTEWORTHY Using a multimodal imaging approach to uncouple tissue deformation from atrial pressure, we found that left ventricular (LV) relaxation is impaired in older obese patients with HFpEF, but only modestly correlates with their severely reduced peak V̇o2. In contrast, the data show a much stronger relationship between elevated LV filling pressures and exercise intolerance, refocusing future therapeutic priorities.


Assuntos
Tolerância ao Exercício , Insuficiência Cardíaca/fisiopatologia , Obesidade/fisiopatologia , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Idoso , Estudos de Casos e Controles , Diástole , Ecocardiografia Doppler , Teste de Esforço , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Consumo de Oxigênio , Disfunção Ventricular Esquerda/diagnóstico por imagem , Pressão Ventricular
4.
Nat Commun ; 11(1): 5355, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097705

RESUMO

Water and lipids are key participants in many biological processes, but there are few non-invasive methods that provide quantification of these components in vivo, and none that can isolate and quantify lipids in the blood. Here we develop a new imaging modality termed shortwave infrared meso-patterned imaging (SWIR-MPI) to provide label-free, non-contact, spatial mapping of water and lipid concentrations in tissue. The method utilizes patterned hyperspectral illumination to target chromophore absorption bands in the 900-1,300 nm wavelength range. We use SWIR-MPI to monitor clinically important physiological processes including edema, inflammation, and tumor lipid heterogeneity in preclinical models. We also show that SWIR-MPI can spatially map blood-lipids in humans, representing an example of non-invasive and contact-free measurements of in vivo blood lipids. Together, these results highlight the potential of SWIR-MPI to enable new capabilities in fundamental studies and clinical monitoring of major conditions including obesity, cancer, and cardiovascular disease.


Assuntos
Raios Infravermelhos , Lipídeos/sangue , Imagem Óptica/métodos , Ondas de Rádio , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Água/análise , Tecido Adiposo Marrom/diagnóstico por imagem , Tecido Adiposo Marrom/patologia , Adulto , Animais , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico por imagem , Edema/diagnóstico por imagem , Edema/patologia , Feminino , Xenoenxertos , Humanos , Inflamação/diagnóstico por imagem , Inflamação/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Obesidade/diagnóstico por imagem , Imagem Óptica/instrumentação , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Espectroscopia de Luz Próxima ao Infravermelho/instrumentação
5.
PLoS One ; 15(8): e0236667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756570

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. METHODS: In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. RESULTS: Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. CONCLUSION: PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Rigidez Vascular/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia
6.
PLoS One ; 15(7): e0236323, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706814

RESUMO

Obesity and regional adiposity are important risk factors for cardiometabolic disorders. The aim of this study is to compare 7-site skinfold (SF) measurement to dual-energy x-ray absorptiometry (DXA) as the reference method for estimating body fat percentage (BF%) and regional adiposity in diabetic outpatients. A total of 59 diabetic patients (36 females and 23 males) aged 28.5-78 years (median 67.7 years) with BMI 18.8-40.6 kg/m2 (median: 25.5 kg/m2) were enrolled. 7-site skinfold measurement and DXA were performed at the same visit day and biochemistry data were collected. Our results demonstrate the BF% calculated via Jackson & Pollock 7-site skinfold equation presents a strong correlation (r = 0.672, p < 0.001 in females; r = 0.885, p < 0.001 in males) with that measured by DXA, but the means of BF% between these two methods are significantly different in both sexes (paired t-test, p < 0.001). The Bland-Altman analysis showed the mean differences (DXA-SF) of BF% were positive for female (8.74%) and male (7.22%), suggesting Jackson & Pollock 7-site skinfold equation tends to underestimate the BF%. Besides, regional SF thicknesses of 7-site skinfold measurement were significantly correlated with the matched regional adiposity quantified by DXA. Furthermore, truncal and android SF thicknesses were notably positively correlated with several cardiometabolic risk factors in gender-specific manner. Our data indicate the 7-site skinfold measurement is not an interchangeable method for precisely measuring BF%, but might be practical for evaluating the cardiometabolic risks in Taiwanese diabetic outpatients.


Assuntos
Absorciometria de Fóton/métodos , Tecido Adiposo/diagnóstico por imagem , Adiposidade , Obesidade/diagnóstico por imagem , Pregas Cutâneas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
7.
Nat Commun ; 11(1): 3755, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32709874

RESUMO

Obesity is associated with low-grade chronic inflammation promoting insulin-resistance and diabetes. Gut microbiota dysbiosis is a consequence as well as a driver of obesity and diabetes. Mucosal-associated invariant T cells (MAIT) are innate-like T cells expressing a semi-invariant T cell receptor restricted to the non-classical MHC class I molecule MR1 presenting bacterial ligands. Here we show that during obesity MAIT cells promote inflammation in both adipose tissue and ileum, leading to insulin resistance and impaired glucose and lipid metabolism. MAIT cells act in adipose tissue by inducing M1 macrophage polarization in an MR1-dependent manner and in the gut by inducing microbiota dysbiosis and loss of gut integrity. Both MAIT cell-induced tissue alterations contribute to metabolic dysfunction. Treatment with MAIT cell inhibitory ligand demonstrates its potential as a strategy against inflammation, dysbiosis and metabolic disorders.


Assuntos
Disbiose/imunologia , Inflamação/patologia , Intestinos/patologia , Células T Invariáveis Associadas à Mucosa/patologia , Obesidade/metabolismo , Tecido Adiposo/patologia , Animais , Citocinas/genética , Citocinas/metabolismo , Dieta Hiperlipídica , Disbiose/complicações , Microbioma Gastrointestinal , Teste de Tolerância a Glucose , Íleo/patologia , Inflamação/complicações , Mucosa Intestinal/patologia , Intestinos/diagnóstico por imagem , Ligantes , Contagem de Linfócitos , Macrófagos/metabolismo , Imagem por Ressonância Magnética , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/complicações , Obesidade/diagnóstico por imagem , Fenótipo , Pterinas/farmacologia , Receptores de Antígenos de Linfócitos T/metabolismo
8.
PLoS One ; 15(6): e0233915, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484819

RESUMO

Cognitive control and incentive sensitivity are related to overeating and obesity. Optimal white matter integrity is relevant for an efficient interaction among reward-related brain regions. However, its relationship with sensitivity to incentives remains controversial. The aim of this study was to assess the incentive sensitivity and its relationship to white matter integrity in normal-weight and overweight groups. Seventy-six young adults participated in this study: 31 were normal-weight (body mass index [BMI] 18.5 to < 25.0 kg/m2, 14 females) and 45 were overweight (BMI ≥ 25.0 kg/m2, 22 females). Incentive sensitivity was assessed using an antisaccade task that evaluates the effect of incentives (neutral, reward, and loss avoidance) on cognitive control performance. Diffusion tensor imaging studies were performed to assess white matter integrity. The relationship between white matter microstructure and incentive sensitivity was investigated through tract-based spatial statistics. Behavioral antisaccade results showed that normal-weight participants presented higher accuracy (78.0 vs. 66.7%, p = 0.01) for loss avoidance incentive compared to overweight participants. Diffusion tensor imaging analysis revealed a positive relationship between fractional anisotropy and loss avoidance accuracy in the normal-weight group (p < 0.05). No relationship reached significance in the overweight group. These results support the hypothesis that white matter integrity is relevant for performance in an incentivized antisaccade task.


Assuntos
Encéfalo/diagnóstico por imagem , Sistema Nervoso Central/fisiopatologia , Cognição/fisiologia , Obesidade/fisiopatologia , Adulto , Anisotropia , Índice de Massa Corporal , Encéfalo/fisiologia , Mapeamento Encefálico , Sistema Nervoso Central/diagnóstico por imagem , Chile/epidemiologia , Imagem de Tensor de Difusão , Movimentos Oculares/fisiologia , Feminino , Humanos , Masculino , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Perda de Peso/fisiologia , Substância Branca/diagnóstico por imagem , Substância Branca/fisiologia , Adulto Jovem
9.
Sci Rep ; 10(1): 6863, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32322021

RESUMO

Obesity and relative leucocyte telomere length (RTL) are both linked to accelerated aging and premature mortality. We examined if nuchal subcutaneous adipose tissue (SAT) thickness, a surrogate marker of central trunk-weighted obesity, is an independent predictor of RTL that provides information beyond BMI, metabolic and inflammatory markers. RTL and nuchal SAT thickness were determined in 362 participants of the STYJOBS/EDECTA study (STYrian Juvenile Obesity Study, Early DEteCTion of atherosclerosis), which included overweight individuals and matched eutrophic controls. Fasting plasma samples were used for the measurement of leptin, resistin, adiponectin, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), liver enzymes, creatinine, cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, oxidized LDL, triglycerides, homocysteine and uric acid. Furthermore, all participants underwent carotid artery ultrasound. Obese individuals had markedly higher body mass index (BMI), nuchal SAT thickness, hip and waist circumferences and carotid intima media thickness (IMT) than eutrophic controls. In addition, they showed typical biochemical abnormalities related to energy metabolism, systemic inflammation and liver function. RTL was inversely correlated with nuchal SAT thickness, IMT, hs-CRP, alkaline phosphatase, insulin, resistin, and leptin. Positive correlations were seen with homocysteine and creatinine. Stepwise linear regression analyses identified nuchal SAT thickness and insulin as the only significant predictors of RTL. In conclusion, nuchal SAT thickness is a robust predictor of RTL that provides information beyond traditional obesity-related metabolic and inflammatory biomarkers. This suggests an important role of fat depots at the neck for accelerated telomere shortening.


Assuntos
Índice de Massa Corporal , Espessura Intima-Media Carotídea , Insulina/sangue , Lipogênese , Medição da Translucência Nucal , Obesidade , Encurtamento do Telômero , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico por imagem
10.
Sci Rep ; 10(1): 6636, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313106

RESUMO

The effect of excessive gestational weight gain (EGWG) is related to adverse health outcomes in the offspring; however, its effect on the daughters' breast density is unclear. We aimed to assess the association between EGWG and daughters' breast composition (% of fibroglandular volume (%FGV) and absolute fibroglandular volume (AFGV)) at Tanner stage 4 (Tanner B4)). We included 341 girls and their mothers from an ongoing cohort of low-income Chilean girls born from 2002-2003. Maternal gestational weight gain was self-reported in 2007, and breast density by digital mammography was measured in 2010. Weight, height and breast composition by dual X-ray absorptiometry (DXA) were measured in daughters at Tanner B4. Logistic regression models were run to assess the association between EGWG and the 80th percentile of %FGV and AFGV. Mean gestational weight gain was 13.7 kg (SD = 6.9 kg). Women with pregestational overweight or obesity exceeded the recommended gestational weight gain (58.8% vs. 31.8%, respectively). Daughters of women who had EGWG had higher levels of AFGV (OR: 2.02; 95%CI 1.16-3.53) at Tanner B4, which could be explained by metabolic and hormonal exposure in utero. However, we did not observe an association with %FGV.


Assuntos
Densidade da Mama/fisiologia , Ganho de Peso na Gestação , Glândulas Mamárias Humanas/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Maturidade Sexual/fisiologia , Absorciometria de Fóton , Adolescente , Adulto , Criança , Chile , Feminino , Humanos , Padrões de Herança , Modelos Logísticos , Estudos Longitudinais , Glândulas Mamárias Humanas/metabolismo , Mamografia , Mães , Núcleo Familiar , Obesidade/metabolismo , Obesidade/fisiopatologia , Gravidez
11.
PLoS One ; 15(4): e0231662, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315336

RESUMO

Early detection of obesity-related glomerulopathy in humans is challenging as it might not be detected by routine biomarkers of kidney function. This study's aim was to use novel kidney biomarkers and contrast-enhanced ultrasound (CEUS) to evaluate the effect of obesity development and weight-loss on kidney function, perfusion, and injury in dogs. Sixteen healthy lean adult beagles were assigned randomly but age-matched to a control group (CG) (n = 8) fed to maintain a lean body weight (BW) for 83 weeks; or to a weight-change group (WCG) (n = 8) fed the same diet to induce obesity (week 0-47), to maintain stable obese weight (week 47-56) and to lose BW (week 56-83). At 8 time points, values of systolic blood pressure (sBP); serum creatinine (sCr); blood urea nitrogen (BUN); serum cystatin C (sCysC); urine protein-to-creatinine ratio (UPC); and urinary biomarkers of glomerular and tubular injury were measured. Glomerular filtration rate (GFR) and renal perfusion using CEUS were assayed (except for week 68). For CEUS, intensity- and time-related parameters representing blood volume and velocity were derived from imaging data, respectively. At 12-22% weight-gain, cortical time-to-peak, representing blood velocity, was shorter in the WCG vs. the CG. After 37% weight-gain, sCysC, UPC, glomerular and tubular biomarkers of injury, urinary immunoglobulin G and urinary neutrophil gelatinase-associated lipocalin, respectively, were higher in the WCG. sBP, sCr, BUN and GFR were not significantly different. After 23% weight-loss, all alterations were attenuated. Early weight-gain in dogs induced renal perfusion changes measured with CEUS, without hyperfiltration, preceding increased urinary protein excretion with potential glomerular and tubular injury. The combined use of routine biomarkers of kidney function, CEUS and site-specific urinary biomarkers might be valuable in assessing kidney health of individuals at risk for obesity-related glomerulopathy in a non-invasive manner.


Assuntos
Glomerulonefrite/metabolismo , Glomérulos Renais/metabolismo , Túbulos Renais/metabolismo , Obesidade/metabolismo , Ganho de Peso/genética , Animais , Biomarcadores/urina , Nitrogênio da Ureia Sanguínea , Meios de Contraste/farmacologia , Creatinina/sangue , Modelos Animais de Doenças , Cães , Taxa de Filtração Glomerular , Glomerulonefrite/etiologia , Glomerulonefrite/patologia , Glomerulonefrite/urina , Humanos , Glomérulos Renais/diagnóstico por imagem , Glomérulos Renais/lesões , Glomérulos Renais/patologia , Túbulos Renais/diagnóstico por imagem , Túbulos Renais/lesões , Túbulos Renais/patologia , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/patologia , Ultrassonografia , Sistema Urinário/metabolismo , Sistema Urinário/patologia , Ganho de Peso/fisiologia , Perda de Peso/genética , Perda de Peso/fisiologia
12.
Am J Trop Med Hyg ; 102(6): 1198-1202, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32333544

RESUMO

Patients with novel coronavirus disease (COVID-19) typically present with bilateral multilobar ground-glass opacification with a peripheral distribution. The utility of point-of-care ultrasound has been suggested, but detailed descriptions of lung ultrasound findings are not available. We evaluated lung ultrasound findings in 10 patients admitted to the internal medicine ward with COVID-19. All of the patients had characteristic glass rockets with or without the Birolleau variant (white lung). Thick irregular pleural lines and confluent B lines were also present in all of the patients. Five of the 10 patients had small subpleural consolidations. Point-of-care lung ultrasound has multiple advantages, including lack of radiation exposure and repeatability. Also, lung ultrasound has been shown to be more sensitive than a chest radiograph in detecting alveolar-interstitial syndrome. The utilization of lung ultrasound may also reduce exposure of healthcare workers to severe acute respiratory syndrome-coronavirus-2 and may mitigate the shortage of personal protective equipment. Further studies are needed to evaluate the utility of lung ultrasound in the diagnosis and management of COVID-19.


Assuntos
Asma/diagnóstico por imagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , Asma/patologia , Asma/terapia , Asma/virologia , Betacoronavirus/genética , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Humanos , Hipertensão/patologia , Hipertensão/terapia , Hipertensão/virologia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Obesidade/terapia , Obesidade/virologia , Oxigênio/uso terapêutico , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ultrassonografia
13.
Psychiatry Res Neuroimaging ; 298: 111047, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32114310

RESUMO

Electroacupuncture (EA) is a safe method for treating obesity; however, its underlying neural mechanisms remain unclear. We employed resting-state-functional-magnetic-resonance-imaging (RS-fMRI) and amplitude-of-low-frequency-fluctuation (ALFF) to investigate acute/long-term effects of EA on brain activity and resting-state-functional-connectivity (RSFC) in overweight/obesity subjects who received real/Sham stimulation. For acute effects, 26 and 19 overweight/obesity subjects were included in EA and Sham groups respectively. There were significant time effects on ALFF in the right insula (INS) and left dorsolateral-prefrontal-cortex (DLPFC) due to decreases/increases in INS/DLPFC in both groups. There were weaker positive RSFC between INS and supplementary-motor-area (SMA)/right DLPFC and weaker negative RSFC between INS and precuneus (PCUN); stronger negative RSFC between DLPFC and dorsomedial-prefrontal-cortex (DMPFC) in both groups. For long-term study, body-mass-index (BMI) had significant reduction in EA (n = 17) and Sham (15) groups; EA had higher BMI reduction than in Sham. There were significant time effects on ALFF in right ventrolateral-prefrontal-cortex (VLPFC) due to significant increases in EA group, and stronger positive RSFC between VLPFC and orbitofrontal-cortex and negative RSFC between VLPFC and left thalamus (THA) in both groups after long-term treatment. These findings suggest that changes in resting-activity and RSFC implicated in inhibitory-control, gastric-motility and satiety-control are associated with EA-induced weight-loss.


Assuntos
Córtex Cerebral/fisiopatologia , Conectoma , Eletroacupuntura , Avaliação de Resultados em Cuidados de Saúde , Sobrepeso/fisiopatologia , Sobrepeso/terapia , Tálamo/fisiopatologia , Perda de Peso , Adulto , Córtex Cerebral/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Obesidade/terapia , Sobrepeso/diagnóstico por imagem , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia , Tálamo/diagnóstico por imagem
14.
Updates Surg ; 72(2): 493-502, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32189194

RESUMO

Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is an increasingly used bariatric surgical procedure. This surgical technique is effective in terms of both weight loss and the resolution of comorbidities, but it is not without complications. To report our experience in MGB/OAGB, assessing comorbidities and complications, and to illustrate post-surgical anatomy and radiological appearance of complications, a single-centre retrospective study of 953 patients undergoing MGB/OAGB between January 2005 and September 2018 was done. The inclusion criteria: body mass index (BMI) of 40 kg/m2 or higher or BMI between 35 and 40 kg/m2 with significant comorbidities not responsive to medical therapies. In the postoperative period, all patients were evaluated with clinical and laboratory tests and radiological examinations (upper gastrointestinal series, computed tomography and magnetic resonance imaging). Median weight was 126.69 kg and mean BMI was 49.4 kg/m2. Regarding comorbidities, 37.2%, 52.8%, 46.7% and 43.2% of patients presented with preoperatively diagnosed type 2 diabetes mellitus (T2DM), hypertensive disease, dyslipidaemia and obstructive sleep apnoea syndrome (OSAS), respectively. Median excess weight loss at 6, 12, 24 and 60 months after surgery was 33.45%, 53.81%, 68.75% and 68.80%, respectively. The remission of comorbidities was 91.4% for T2DM, 93.7% for hypertensive disease, 90.3% for dyslipidemia and 93.4% for OSAS. Early and late complication rates identified with radiological examinations were 1.5% and 1.6%, respectively. MGB/OAGB was effective for weight loss and comorbidities remission. Complications occurred at lower rate than with other surgical procedures were identified with imaging; CT was the main radiological technique.


Assuntos
Anastomose Cirúrgica/métodos , Derivação Gástrica/métodos , Laparoscopia/métodos , Obesidade/cirurgia , Adolescente , Adulto , Idoso , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Humanos , Hipertensão/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Nutrients ; 12(2)2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32033349

RESUMO

Obese subjects showed different cardiovascular risk depending by different insulin sensitivity status. We investigated the difference in left ventricular mass and geometry between metabolically healthy (MHO) and unhealthy (MUHO) obese subjects. From a cohort of 876 obese subjects (48.3 ± 14.1 years) without cardio-metabolic disease and stratified according to increasing values of Matsuda index after 75 g oral glucose tolerance test, we defined MHO (n = 292) those in the upper tertile and MUHO (n = 292) those in the lower tertile. All participants underwent echocardiographic measurements. Left ventricular mass was calculated by Devereux equation and normalized by height2,7 and left ventricular hypertrophy (LVH) was defined by values >44 g/m2.7 for females and >48 g/m2.7 for males. Left ventricular geometric pattern was defined as concentric or eccentric if relative wall thickness was higher or lower than 0.42, respectively. MHO developed more commonly a concentric remodeling (19.9 vs. 9.9%; p = 0.001) and had a reduced risk for LVH (OR 0.46; p < 0.0001) than MUHO, in which the eccentric type was more prevalent (40.4 vs. 5.1%; p < 0.0001). We demonstrated that obese subjects-matched for age, gender and BMI-have different left ventricular mass and geometry due to different insulin sensitivity status, suggesting that diverse metabolic phenotypes lead to alternative myocardial adaptation.


Assuntos
Intolerância à Glucose/fisiopatologia , Hipertrofia Ventricular Esquerda/epidemiologia , Resistência à Insulina/fisiologia , Obesidade Metabolicamente Benigna/fisiopatologia , Obesidade/fisiopatologia , Adulto , Glicemia/metabolismo , Ecocardiografia , Feminino , Intolerância à Glucose/complicações , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade Metabolicamente Benigna/complicações , Obesidade Metabolicamente Benigna/diagnóstico por imagem , Fenótipo , Prevalência , Fatores de Risco
16.
Arch. endocrinol. metab. (Online) ; 64(1): 24-29, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088778

RESUMO

ABSTRACT Objective A large number of studies have used abdominal computed tomography (CT) to quantify body composition, and different software programmes have been used to perform these analyses. Thus, this comparison is important to enable researchers to know the performance of more accessible software. Subjects and methods Fifty-four abdominal CT scans of obese (BMI 30 to 39.9 kg/m2), sedentary adults (24-41 years) patients from a Brazilian single center were selected. Two software programs were compared: Slice-O-Matic (Tomovision, Canada) version 5.0 and OsiriX version 5.8.5. The body composition analysis were segmented using standard Hounsfield unit (HU) (adipose tissue: -190 to +30 and skeletal muscle: -29 to +150) and measured at the mid third lumbar vertebra (L3) level on a slice showing both transversal processes. Bland-Altman limits of agreement analyses were used to assess the level of agreement between Slice-O-Matic and OsiriX. Results A total of fifty-four participants were evaluated, with majority women (69%), mean of age 31.3 (SD 6.5) years and obesity grade I most prevalent (74.1%). The agreement, in Bland-Altman analysis, between Slice-O-Matic and OsiriX analisys for the muscle mass tissue, visceral adipose tissue and subcutaneous adipose tissue were excellent (≥ 0.954) with P-values < 0.001. Conclusion These findings show that Slice-O-Matic and OsiriX softwares agreement in measurements of skeletal muscle and adipose tissue and sarcopenia diagnosis in obese patients, suggesting good applicability in studies with body composition in this population and clinical practice.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Composição Corporal , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Subcutânea/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Comportamento Sedentário
17.
Diabetes ; 69(4): 567-577, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31915151

RESUMO

Reduced storage of dietary fatty acids (DFAs) in abdominal adipose tissues with enhanced cardiac partitioning has been shown in subjects with type 2 diabetes (T2D) and prediabetes. We measured DFA metabolism and organ partitioning using positron emission tomography with oral and intravenous long-chain fatty acid and glucose tracers during a standard liquid meal in 12 obese subjects with T2D before and 8-12 days after bariatric surgery (sleeve gastrectomy or sleeve gastrectomy and biliopancreatic diversion with duodenal switch). Bariatric surgery reduced cardiac DFA uptake from a median (standard uptake value [SUV]) 1.75 (interquartile range 1.39-2.57) before to 1.09 (1.04-1.53) after surgery (P = 0.01) and systemic DFA spillover from 56.7 mmol before to 24.7 mmol over 6 h after meal intake after surgery (P = 0.01), with a significant increase in intra-abdominal adipose tissue DFA uptake from 0.15 (0.04-0.31] before to 0.49 (0.20-0.59) SUV after surgery (P = 0.008). Hepatic insulin resistance was significantly reduced in close association with increased DFA storage in intra-abdominal adipose tissues (r = -0.79, P = 0.05) and reduced DFA spillover (r = 0.76, P = 0.01). We conclude that bariatric surgery in subjects with T2D rapidly reduces cardiac DFA partitioning and hepatic insulin resistance at least in part through increased intra-abdominal DFA storage and reduced spillover.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/metabolismo , Ácidos Graxos/metabolismo , Resistência à Insulina/fisiologia , Gordura Intra-Abdominal/metabolismo , Fígado/metabolismo , Miocárdio/metabolismo , Obesidade/cirurgia , Adulto , Glicemia/metabolismo , Composição Corporal/fisiologia , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/metabolismo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
J Clin Neurosci ; 73: 280-287, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31992512

RESUMO

The morphological changes of the brain, particularly in the integrity of white and gray matter and the cortical thickness of brain, have been investigated extensively in obese patients. While there has been a growing amount of evidence indicating that subcortical structures are associated with obesity, studies on the volume of subregional level including shape alterations using high-field MRI are very sparse. The aim of this study was to evaluate and compare the volumes of 14 subcortical structures (bilateral thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens) in obese and normal-weighted subjects using 3T MRI for high resolution imaging. Fifty-four volunteers, 27 obesity (age = 23.15 ± 3.22, body mass index (BMI) = 30.12 ± 3.77) and 27 normal weighted controls (age = 26.1 ± 5.78, BMI = 21.76 ± 1.74) participated in the study. Through volumetric analysis, we found that the obese subjects had enlarged bilateral thalamus, putamen, pallidus and hippocampus, reduced bilateral caudate in obese groups in comparison to normal-weighted groups. Furthermore, we found that the medial-dorsal part of bilateral caudate significantly shrank while the lateral-dorsal part of bilateral thalamus significantly increased through vertex-based analysis (p < 0.05). Thus, based on our evidence, we suggest that subcortical structures are associated with feeding behavior and sensory function in obese patients.


Assuntos
Gânglios da Base/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Tálamo/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino
19.
Radiology ; 294(3): 669-675, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31990265

RESUMO

Background There is significant pulmonary functional deficit related to obesity, but no prospective CT studies have evaluated the effects of obesity on the lungs and trachea. Purpose To evaluate lung parenchymal and tracheal CT morphology before and 6 months after bariatric surgery, with functional and symptomatic correlation. Materials and Methods A prospective longitudinal study of 51 consecutive individuals referred for bariatric surgery was performed (from November 2011 to November 2013). All individuals had undergone limited (three-location) inspiratory and end-expiratory thoracic CT before and after surgery, with concurrent pulmonary function testing, body mass index calculation, and modified Medical Research Council (mMRC) dyspnea scale and Epworth scoring. Two thoracic radiologists scored the CT extent of mosaic attenuation, end-expiratory air trapping, and tracheal shape. The inspiratory and end-expiratory cross-sectional areas of the trachea were measured. The paired t test or Wilcoxon signed-rank test was used for pre- and postsurgical comparisons. Spearman correlation and logistic regression were used to evaluate correlations between CT findings and functional and symptom indexes. Results A total of 51 participants (mean age, 52 years ± 8 [standard deviation]; 20 men) were evaluated. Before surgery, air trapping extent correlated most strongly with decreased total lung capacity (Spearman rank correlation coefficient [rs] = -0.40, P = .004). After surgery, there were decreases in percentage mosaic attenuation (0% [interquartile range {IQR}: 0%-2.5%] vs 0% [IQR: 0%-0%], P < .001), air trapping (9.6% [IQR: 5.8%-15.8%] vs 2.5% [IQR: 0%-6.7%], P < .001), and tracheal collapse (201 mm2 [IQR: 181-239 mm2] vs 229 mm2 [186-284 mm2], P < .001). After surgery, mMRC dyspnea score change correlated positively with air trapping extent change (rs = 0.46, P = .001) and end-expiratory tracheal shape change (rs = 0.40, P = .01). At multivariable analysis, air trapping was the main determinant for decreased dyspnea after surgery (odds ratio, 1.2; 95% confidence interval: 1.1, 1.2; P = .03). Conclusion Dyspnea improved in obese participants after weight reduction, which correlated with less tracheal collapse and air trapping at end-expiration chest CT. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Cirurgia Bariátrica , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Adulto , Humanos , Estudos Longitudinais , Pulmão/anatomia & histologia , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Obesidade/patologia , Obesidade/cirurgia , Estudos Prospectivos , Traqueia/anatomia & histologia , Resultado do Tratamento
20.
Am J Clin Nutr ; 111(3): 493-502, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31940031

RESUMO

BACKGROUND: Food advertising is a major contributor to obesity, and fast food (FF) restaurants are top advertisers. Research on the impact of food advertising in adolescents is lacking and no prior research has investigated neural predictors of food intake in adolescents. Neural systems implicated in reward could be key to understanding how food advertising drives food intake. OBJECTIVES: To investigate how neural responses to both unhealthy and healthier FF commercials predict food intake in adolescents. METHODS: A cross-sectional sample of 171 adolescents (aged 13-16 y) who ranged from normal weight to obese completed an fMRI paradigm where they viewed unhealthy and healthier FF and nonfood commercials. Adolescents then consumed a meal in a simulated FF restaurant where foods of varying nutritional profiles (unhealthy compared with healthier) were available. RESULTS: Greater neural activation in reward-related regions (nucleus accumbens, r = 0.29; caudate nucleus, r = 0.27) to unhealthy FF commercials predicted greater total food intake. Greater responses to healthier FF relative to nonfood commercials in regions associated with reward (i.e., nucleus accumbens, r = 0.24), memory (i.e., hippocampus, r = 0.32), and sensorimotor processes (i.e., anterior cerebellum, r = 0.33) predicted greater total food and unhealthier food intake, but not healthier food intake. Lower activation in neural regions associated with visual attention and salience (e.g., precuneus, r = -0.35) to unhealthy relative to healthier FF commercials predicted healthier food intake. CONCLUSIONS: These findings suggest that FF commercials contribute to overeating in adolescents through reward mechanisms. The addition of healthier commercials from FF restaurants is unlikely to encourage healthier food intake, but interventions that reduce the ability of unhealthy FF commercials to capture attention could be beneficial. However, an overall reduction in the amount of FF commercials exposure for adolescents is likely to be the most effective approach.


Assuntos
Encéfalo/fisiologia , Ingestão de Alimentos , Fast Foods/economia , Obesidade/fisiopatologia , Adolescente , Publicidade , Encéfalo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Obesidade/diagnóstico por imagem , Recompensa , Televisão
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