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1.
BMJ ; 367: l5584, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619383

RESUMO

OBJECTIVE: To investigate the association between weight changes across adulthood and mortality. DESIGN: Prospective cohort study. SETTING: US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014. PARTICIPANTS: 36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline). MAIN OUTCOME MEASURES: All cause and cause specific mortality from baseline until 31 December 2015. RESULTS: During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality. CONCLUSIONS: Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.


Assuntos
Doenças Cardiovasculares , Causas de Morte , Mortalidade Prematura/tendências , Mortalidade/tendências , Neoplasias , Ganho de Peso , Perda de Peso , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Inquéritos Nutricionais , Obesidade/diagnóstico , Obesidade/mortalidade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Razão Cintura-Estatura
2.
Medicine (Baltimore) ; 98(39): e17303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574857

RESUMO

Treatment with nitisinone (NTBC) has brought about a drastic improvement in the treatment and prognosis of hereditary tyrosinemia type I (HT1). We conducted a retrospective observational multicentric study in Spanish HT1 patients treated with NTBC to assess clinical and biochemical long-term evolution.We evaluated 52 patients, 7 adults and 45 children, treated with NTBC considering: age at diagnosis, diagnosis by clinical symptoms, or by newborn screening (NBS); phenotype (acute/subacute/chronic), mutational analysis; symptoms at diagnosis and clinical course; biochemical markers; doses of NTBC; treatment adherence; anthropometric evolution; and neurocognitive outcome.The average follow-up period was 6.1 ±â€Š4.9 and 10.6 ±â€Š5.4 years in patients with early and late diagnosis respectively. All patients received NTBC from diagnosis with an average dose of 0.82 mg/kg/d. All NBS-patients (n = 8) were asymptomatic at diagnosis except 1 case with acute liver failure, and all remain free of liver and renal disease in follow-up. Liver and renal affectation was markedly more frequent at diagnosis in patients with late diagnosis (P < .001 and .03, respectively), with ulterior positive hepatic and renal course in 86.4% and 93.2% of no-NBS patients, although 1 patient with good metabolic control developed hepatocarcinoma.Despite a satisfactory global nutritional evolution, 46.1% of patients showed overweight/obesity. Interestingly lower body mass index was observed in patients with good dietary adherence (20.40 ±â€Š4.43 vs 24.30 ±â€Š6.10; P = .08) and those with good pharmacological adherence (21.19 ±â€Š4.68 vs 28.58 ±â€Š213.79).intellectual quotient was ≥85 in all NBS- and 68.75% of late diagnosis cases evaluated, 15% of which need pedagogical support, and 6.8% (3/44) showed school failure.Among the 12 variants identified in fumarylacetoacetate hydrolase gene, 1 of them novel (H63D), the most prevalent in Spanish population is c.554-1 G>T.After NTBC treatment a reduction in tyrosine and alpha-fetoprotein levels was observed in all the study groups, significant for alpha-fetoprotein in no NBS-group (P = .03), especially in subacute/chronic forms (P = .018).This series confirms that NTBC treatment had clearly improved the prognosis and quality of life of HT1 patients, but it also shows frequent cognitive dysfunctions and learning difficulties in medium-term follow-up, and, in a novel way, a high percentage of overweight/obesity.


Assuntos
Cicloexanonas/uso terapêutico , Diagnóstico Tardio , Nitrobenzoatos/uso terapêutico , Obesidade , Qualidade de Vida , Tirosinemias , Adulto , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Inibidores Enzimáticos/uso terapêutico , Feminino , Seguimentos , Humanos , Recém-Nascido , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Triagem Neonatal/métodos , Obesidade/diagnóstico , Obesidade/etiologia , Prognóstico , Estudos Retrospectivos , Espanha , Tempo para o Tratamento , Tirosinemias/complicações , Tirosinemias/diagnóstico , Tirosinemias/tratamento farmacológico , Tirosinemias/psicologia
3.
Acta méd. costarric ; 61(3): 111-118, jul.-sep. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1019302

RESUMO

Resumen Objetivo : El objetivo del estudio fue analizar el consumo de azúcares añadidos por la población urbana costarricense y los factores asociados a este. Método: Estudio transversal donde se analizan los datos de 798 participantes del Estudio ELANS-Costa Rica, que constituyen una muestra representativa de la población urbana costarricense, (con edades entre 15 y 65 años). Para conocer el consumo de azúcares añadidos, se realizan dos recordatorios de 24 horas, en días no consecutivos. Se recolectan variables sociodemográficas, cantidad, lugar y momento del consumo. Resultados: El consumo de azúcares añadidos representa el 14,7% de la energía consumida por la población urbana costarricense, siendo este porcentaje mayor en las mujeres y en las personas más jóvenes. La mayor cantidad de azúcares añadidos se consume en el hogar y durante las meriendas. Las bebidas azucaradas constituyen la principal fuente de azúcares añadidos en la dieta costarricense, y las bebidas gaseosas son la fuente más importante en el quintil de mayor consumo. Conclusión: La ingesta de energía obtenida de los azúcares añadidos supera la recomendación máxima establecida por la Organización Mundial de la Salud, por lo tanto, es necesario establecer políticas públicas dirigidas a reducir su consumo y a la modificación de conductas asociadas a la preparación e ingesta de alimentos fuente de azúcares añadidos.


Abstract Aim: High consumption of added sugars has been associated with a greater risk of chronic diseases, appearance of caries and weight gain, which implies a lower quality of life for the population and an increase in costs for the health system. The aim of this study was to evaluate the intake of added sugar and its related factors in urban Costa Rican population. Methods : This was a cross-sectional study conducted in a representative sample of the Costa Rican urban population (798 participants aged between 15 and 65 years). To determine the consumption of added sugars, two 24 hours recalls were conducted, in non-consecutive days. Sociodemographic variables, quantity of food consumed, place and time of consumption were collected. Results: The consumption of added sugars represents 14.7% of total energy intake for the Costa Rican urban population. This consumption is higher among women and younger people. The greater amount of added sugars was consumed in the home and during snacks. Sugar-sweetened beverages were the main source of this added sugar in the Costa Rican diet and soft drinks were the most important source in the highest consumption quintile. Conclusions: The intake of energy obtained from the added sugars exceeds the máximum recommendation established by the World Health Organization, therefore it is necessary to establish public policies aimed at reducing consumption and modifying behaviors associated with the preparation and intake of food source of added sugars.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Bebidas Gaseificadas/efeitos adversos , Diabetes Mellitus/patologia , Açúcares/análise , Açúcares da Dieta/administração & dosagem , Obesidade/diagnóstico , Costa Rica
4.
BMC Public Health ; 19(1): 1035, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375086

RESUMO

BACKGROUND: To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors. METHODS: A large-scale cross-sectional survey was conducted among 35,256 adults aged 20-74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors. RESULTS: The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60-74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes. CONCLUSIONS: WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.


Assuntos
Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Obesidade/diagnóstico , Circunferência da Cintura , Razão Cintura-Estatura , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores de Risco , Adulto Jovem
5.
BMJ ; 366: l4293, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340931

RESUMO

OBJECTIVES: To develop and validate a prediction model for fat mass in children aged 4-15 years using routinely available risk factors of height, weight, and demographic information without the need for more complex forms of assessment. DESIGN: Individual participant data meta-analysis. SETTING: Four population based cross sectional studies and a fifth study for external validation, United Kingdom. PARTICIPANTS: A pooled derivation dataset (four studies) of 2375 children and an external validation dataset of 176 children with complete data on anthropometric measurements and deuterium dilution assessments of fat mass. MAIN OUTCOME MEASURE: Multivariable linear regression analysis, using backwards selection for inclusion of predictor variables and allowing non-linear relations, was used to develop a prediction model for fat-free mass (and subsequently fat mass by subtracting resulting estimates from weight) based on the four studies. Internal validation and then internal-external cross validation were used to examine overfitting and generalisability of the model's predictive performance within the four development studies; external validation followed using the fifth dataset. RESULTS: Model derivation was based on a multi-ethnic population of 2375 children (47.8% boys, n=1136) aged 4-15 years. The final model containing predictor variables of height, weight, age, sex, and ethnicity had extremely high predictive ability (optimism adjusted R2: 94.8%, 95% confidence interval 94.4% to 95.2%) with excellent calibration of observed and predicted values. The internal validation showed minimal overfitting and good model generalisability, with excellent calibration and predictive performance. External validation in 176 children aged 11-12 years showed promising generalisability of the model (R2: 90.0%, 95% confidence interval 87.2% to 92.8%) with good calibration of observed and predicted fat mass (slope: 1.02, 95% confidence interval 0.97 to 1.07). The mean difference between observed and predicted fat mass was -1.29 kg (95% confidence interval -1.62 to -0.96 kg). CONCLUSION: The developed model accurately predicted levels of fat mass in children aged 4-15 years. The prediction model is based on simple anthropometric measures without the need for more complex forms of assessment and could improve the accuracy of assessments for body fatness in children (compared with those provided by body mass index) for effective surveillance, prevention, and management of clinical and public health obesity.


Assuntos
Tecido Adiposo/patologia , Antropometria/métodos , Obesidade , Adolescente , Criança , Pré-Escolar , Humanos , Modelos Teóricos , Obesidade/diagnóstico , Obesidade/prevenção & controle , Valor Preditivo dos Testes
6.
Medicine (Baltimore) ; 98(29): e16438, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335698

RESUMO

In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1-2017Q1 (first = index). Patients' body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.


Assuntos
Artroplastia do Joelho , Cirurgia Bariátrica , Ablação por Cateter , Codificação Clínica , Herniorrafia , Obesidade/diagnóstico , Adulto , Idoso , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Codificação Clínica/métodos , Codificação Clínica/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Seleção de Pacientes , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
7.
High Blood Press Cardiovasc Prev ; 26(3): 227-237, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31228169

RESUMO

INTRODUCTION: Contribution of risk factors for cardiovascular-related deaths in the Eastern Mediterranean Region Organization (EMRO) is not estimated quantitatively. AIM: To determine the avoidable burden of cardiovascular diseases (CVDs) due to hypertension, diabetes, smoking, overweight, and obesity in countries of EMRO of the WHO. METHODS: The comparative risk assessment methodology was used to calculate the potential impact fraction (PIF) and percentage of the avoidable burden of CVD-related death due to associated risk factors. Population exposure levels for CVDs and corresponding measures of association were extracted from published studies. The attributable burden was calculated by multiplying the Disability-Adjusted Life-Years (DALYs) for CVDs by the estimated impact fraction of risk factors. DALYs of the CVDs in all countries of the EMRO were extracted from the GBD official website in 2016. RESULTS: Following reduction of the current prevalence of smoking, obesity, hypertension, diabetes, and overweight to a feasible minimum risk exposure level in Lebanon, about 12.4%, 4.2%, 10.2%, 3.8%, and 5.7% of the burden of CVD-related mortality could be avoidable, respectively. The corresponding values of avoidable burden in selected EMRO countries were 5.1%, 3.5%, 9.4%, 5.9% and 5.3% in Iran and 9.5%, 4.1%, 11%, 8.2% and 5.4% in Egypt. CONCLUSIONS: Findings suggest that health policy makers of all EMRO countries should take into account the attributable burden of CVD-related mortality due to associated risk factors to effectively develop preventive interventions.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , África do Norte/epidemiologia , Ásia/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Estilo de Vida Saudável , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Obesidade/diagnóstico , Obesidade/mortalidade , Obesidade/terapia , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/mortalidade , Abandono do Hábito de Fumar
8.
Health Psychol ; 38(7): 586-595, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31120270

RESUMO

OBJECTIVE: To investigate the separate and combined associations of obesity and metabolic syndrome (MetS) with depression and the role of inflammation. METHOD: Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9) and was defined with a cutpoint of ≥10. Obesity was defined as body mass index (BMI) ≥30 kg/m2 from measured height and weight. MetS was defined based on the American Heart Association consensus definition. Participants were divided into four groups: healthy normal weight (MHN), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUN), and metabolic unhealthy obese (MUO). C-Reactive protein was assessed in a subsample. RESULTS: A total of 18,025 subjects were included in the analysis. Participants with MUO had the highest prevalence of depression compared with the MHN group (14.8% vs. 6.8, p < .001). While both obesity and MetS were independently associated with depression, there was a significant interaction between the two (p < .001), indicating that the associations of obesity and MetS with depression were synergistic. After adjusting for baseline characteristics, compared with the MHN group, the MUO group had the highest odds of depression (odds ratio [OR] = 2.30, 95% CI [2.03, 2.61]), followed by MHO group (OR = 1.51, 95% CI [1.30, 1.74]) and the MUN group (OR = 1.39, 95% CI [1.18, 1.64]). The MUO group also showed the highest level of C-reactive protein, and the latter partially mediated the effect between MUO and depressive symptoms (20.5% of the total effect). CONCLUSION: Both obesity and MetS are associated with depression independent of each other, but when present together, these conditions have a synergistic association with depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/psicologia , Obesidade/epidemiologia , Obesidade/psicologia , Adulto , Idoso , Antropometria/métodos , Índice de Massa Corporal , Peso Corporal/fisiologia , Estudos Transversais , Depressão/diagnóstico , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/epidemiologia , Inflamação/psicologia , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Inquéritos Nutricionais/métodos , Obesidade/diagnóstico , Reprodutibilidade dos Testes , Circunferência da Cintura/fisiologia
9.
Acta Diabetol ; 56(9): 1073-1082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31062097

RESUMO

AIMS: Offspring of mothers suffering from obesity and/or gestational diabetes mellitus (GDM) were reported to be at risk of higher birth weight (BW), later obesity and diabetes. We hypothesize that infant anthropometry changes related to maternal pathological status are due to dysregulated infant metabolism. METHODS: First, we inspected differences in BMI z-scores (z-BMI) between three infant groups: born to normal weight (NW; n = 49), overweight/obese (OV/OB; n = 40) and GDM mothers (n = 27) at birth and 1 year. Then, we inspected associations between cord blood metabolites and 1-year Δ z-BMI in the three infant groups at birth and 1 year. RESULTS: No statistically significant difference was detected in z-BMI between the study groups at birth; however, GDM was associated with heavier infants at 1 year. Regarding the associations between the metabolites and z-BMI, phospholipids, especially those containing polyunsaturated fatty acids, were the species most impacted by the maternal metabolic status, since numerous phosphatidylcholines-PUFA were positively associated with z-BMI in NW but negatively in OV/OB and GDM groups at birth. Conversely, the sum of lysophosphatidylcholines was only positively associated with z-BMI in NW at birth but of no relation in the other two groups. At 1 year, most of the associations seen at birth were reversed in NW and lost in OV/OB and GDM groups. In the NW group, PC-PUFA were found to be negatively associated with Δ z-BMI at 1 year in addition to some medium-chain acylcarnitines, tricarboxylic acid metabolites, Asp and Asn-to-Asp ratio. In OV/OB and GDM groups, the non-esterified fatty acid (NEFA26:0) and His correlated with Δ z-BMI at 1 year in negative and positive directions, respectively. CONCLUSIONS: GDM was associated with overweight in offspring at 1 year, independent of the BW with lack of evidence on existing correlation of this finding with metabolic alterations detected in cord blood metabolome. Associations were found between cord blood metabolites and infant anthropometry at birth and were influenced by maternal OB and GDM. However, an extension of the findings monitored at birth among the three groups was not detected longitudinally showing a lack of predictive power of cord blood metabolome for later development at least 1 year.


Assuntos
Crianças Adultas , Filho de Pais Incapacitados , Diabetes Gestacional , Sangue Fetal/metabolismo , Metaboloma , Obesidade , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Adulto , Crianças Adultas/estatística & dados numéricos , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Filho de Pais Incapacitados/estatística & dados numéricos , Efeito de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Características da Família , Ácidos Graxos não Esterificados/análise , Ácidos Graxos não Esterificados/sangue , Feminino , Sangue Fetal/química , Humanos , Lactente , Recém-Nascido , Masculino , Metabolômica/instrumentação , Metabolômica/métodos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/diagnóstico , Sobrepeso/complicações , Gravidez , Efeitos Tardios da Exposição Pré-Natal/sangue , Efeitos Tardios da Exposição Pré-Natal/diagnóstico
10.
Gut ; 68(8): 1430-1438, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30971437

RESUMO

OBJECTIVE: To investigate the underlying mechanisms behind changes in glucose homeostasis with delivery of propionate to the human colon by comprehensive and coordinated analysis of gut bacterial composition, plasma metabolome and immune responses. DESIGN: Twelve non-diabetic adults with overweight and obesity received 20 g/day of inulin-propionate ester (IPE), designed to selectively deliver propionate to the colon, a high-fermentable fibre control (inulin) and a low-fermentable fibre control (cellulose) in a randomised, double-blind, placebo-controlled, cross-over design. Outcome measurements of metabolic responses, inflammatory markers and gut bacterial composition were analysed at the end of each 42-day supplementation period. RESULTS: Both IPE and inulin supplementation improved insulin resistance compared with cellulose supplementation, measured by homeostatic model assessment 2 (mean±SEM 1.23±0.17 IPE vs 1.59±0.17 cellulose, p=0.001; 1.17±0.15 inulin vs 1.59±0.17 cellulose, p=0.009), with no differences between IPE and inulin (p=0.272). Fasting insulin was only associated positively with plasma tyrosine and negatively with plasma glycine following inulin supplementation. IPE supplementation decreased proinflammatory interleukin-8 levels compared with cellulose, while inulin had no impact on the systemic inflammatory markers studied. Inulin promoted changes in gut bacterial populations at the class level (increased Actinobacteria and decreased Clostridia) and order level (decreased Clostridiales) compared with cellulose, with small differences at the species level observed between IPE and cellulose. CONCLUSION: These data demonstrate a distinctive physiological impact of raising colonic propionate delivery in humans, as improvements in insulin sensitivity promoted by IPE and inulin were accompanied with different effects on the plasma metabolome, gut bacterial populations and markers of systemic inflammation.


Assuntos
Microbioma Gastrointestinal/fisiologia , Insulina/metabolismo , Inulina , Metaboloma/fisiologia , Obesidade , Sobrepeso , Adulto , Índice de Massa Corporal , Estudos Cross-Over , Suplementos Nutricionais , Método Duplo-Cego , Fezes/microbiologia , Feminino , Humanos , Inflamação/metabolismo , Resistência à Insulina/fisiologia , Inulina/administração & dosagem , Inulina/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/dietoterapia , Obesidade/metabolismo , Sobrepeso/diagnóstico , Sobrepeso/dietoterapia , Sobrepeso/metabolismo , Propionatos/administração & dosagem , Propionatos/metabolismo , Resultado do Tratamento
11.
Turk J Med Sci ; 49(2): 583-588, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30997793

RESUMO

Background/aim: The purpose of this study was to determine sarcopenia, sarcopenic obesity and phase angle (PA) and the influence of chemotherapy (CT) on anthropometric measurements and and the PA in in geriatric patients with gastrointestinal (GI) cancer. Materials and methods: The anthropometric measurements, calf circumference (CC), upper midarm circumference (UMAC), and hand grip strength (HGS), have been measured to understand muscle function of 153 patients (mean age of 70.5 ± 5.6 years, 28.8% female, 71.2% male). Sarcopenia and PA measurements have been evaluated by bioelectrical impedance analyses. The same evaluations were checked again after 1 cycle of CT (min: 4, max: 6 weeks). Results: Patient population consisted of colorectal (51,6%), gastric (26.8%), pancreas (11.8%), liver (7.2%), and biliary tract cancer (2%). UMAC (28.5 ± 4.4 before, 28.1 ± 4.9, P = 0.034 after CT), and HGS measurements (27.5 ± 8.6 before, 26.8 ± 8.8 after CT, P = 0.007) have significantly decreased after CT. CC measurement < 31 cm at first visit was seen in 13.1% of patients, but the ratio raised to 20.3% after CT (χ², P = 0.003). Severe sarcopenia was determined in 33% of all patients, and 30.0% of them have been considered as sarcopenic obese. Conclusion: Sarcopenia and sarcopenic obesity were prevalent in this group patients. The CT caused a decrease in muscle functions, UMAC, and CC. Patients should be followed up carefully for sarcopenia, sarcopenic obesity, and nutritional aspect and it would be proper to intervene before sarcopenia has not occurred yet.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/tratamento farmacológico , Avaliação Geriátrica , Músculo Esquelético/fisiopatologia , Obesidade/diagnóstico , Sarcopenia/diagnóstico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Impedância Elétrica , Feminino , Neoplasias Gastrointestinais/fisiopatologia , Força da Mão , Humanos , Masculino , Músculo Esquelético/efeitos dos fármacos , Obesidade/complicações , Obesidade/fisiopatologia , Prevalência , Estudos Prospectivos , Sarcopenia/etiologia , Sarcopenia/fisiopatologia
12.
Nutrients ; 11(4)2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30986960

RESUMO

Dietary carotenoids, plant pigments with anti-oxidant properties, accumulate in neural tissue and are often found in lower concentrations among individuals with obesity. Given previous evidence of negative associations between excess adiposity and memory, it is possible that greater carotenoid status may confer neuroprotective effects among persons with overweight or obesity. This study aimed to elucidate relationships between carotenoids assessed in diet, serum, and the macula (macular pigment optical density (MPOD)) and relational memory among adults who are overweight or obese. Adults aged 25-45 years (N = 94) completed a spatial reconstruction task. Task performance was evaluated for accuracy of item placement during reconstruction relative to the location of the item during the study phase. Dietary carotenoids were assessed using 7-day diet records. Serum carotenoids were measured using high-performance liquid chromatography. Hierarchical linear regression analyses were used to determine the relationship between carotenoids and task performance. Although initial correlations indicated that dietary lutein, beta-carotene, and serum beta-carotene were positively associated with memory performance, these relationships were not sustained following adjustment for age, sex, and BMI. Serum lutein remained positively associated with accuracy in object binding and inversely related to misplacement error after controlling for covariates. Macular carotenoids were not related to memory performance. Findings from this study indicate that among the carotenoids evaluated, lutein may play an important role in hippocampal function among adults who are overweight or obese.


Assuntos
Luteína/sangue , Obesidade/sangue , Obesidade/psicologia , Memória Espacial , Adiposidade , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Cromatografia Líquida de Alta Pressão , Feminino , Hipocampo/fisiopatologia , Humanos , Macula Lutea/química , Pigmento Macular/análise , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Fatores de Tempo
13.
Nutrients ; 11(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30987242

RESUMO

n-3 polyunsaturated fatty acids (PUFAs) have been shown to have preventive effects against depression. In this study, we aimed to investigate the associations between the intake of n-3 PUFAs and depression among people according to sex and weight status. We utilized cross-sectional data from the Shika study in Japan. The study was conducted between 2013 and 2016. Data were collected from adults older than 65 years. Invitation letters were distributed to 2677 individuals, 2470 of whom participated in the study (92.3%). We assessed depressive states using the Japanese short version of the Geriatric Depression Scale (GDS-15). We assessed the intake of n-3 PUFAs using the validated food frequency questionnaire. One thousand six hundred thirty-three participants provided data, among which 327 (20.0%) exhibited depressive symptoms. When we performed the stratified analysis by sex and weight status, there were significant inverse relationships between total n-3 PUFAs, individual n-3 PUFAs, and n-3/n-6 PUFAs ratio and depressive symptoms in overweight/obese females. No correlations were observed between n-3 PUFAs intake and depressive states in males. The results demonstrated a relationship between n-3 PUFAs deficiencies and depressive states, particularly in overweight/obese females. Dietary modifications may help to prevent depressive symptoms in overweight/obese females.


Assuntos
Afeto/efeitos dos fármacos , Peso Corporal , Depressão/epidemiologia , Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Obesidade/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/diagnóstico , Depressão/prevenção & controle , Depressão/psicologia , Ácidos Graxos Ômega-3/deficiência , Feminino , Avaliação Geriátrica/métodos , Humanos , Japão , Masculino , Avaliação Nutricional , Inquéritos Nutricionais , Estado Nutricional , Obesidade/diagnóstico , Obesidade/fisiopatologia , Obesidade/terapia , Prognóstico , Fatores de Proteção , Fatores de Risco , Fatores Sexuais
14.
Trials ; 20(1): 202, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961631

RESUMO

BACKGROUND: To date, surgeons and physicians have found positive results treating metabolic syndrome with surgical and non-surgical weight loss therapies. The purpose of this study was to evaluate changes in telomere length in patients with metabolic syndrome after weight loss. METHODS/DESIGN: This study is a three-arm randomized controlled trial. The first group is composed of patients who have undergone stapleless bypass surgery (one anastomosis gastric bypass with an obstructive stapleless pouch and anastomosis (LOAGB-OSPAN)). The second group of patients underwent standard gastric bypass surgery (laparoscopic mini-gastric bypass-one anastomosis gastric bypass (LMGB-OAGB). The patients in the third group received non-surgical weight loss therapy, including a hypocaloric diet with energy restriction (- 500 kcal/day). The aim is to compare changes-telomere length, body mass index, comorbidities, and quality of life-in patients with metabolic syndrome after weight loss. DISCUSSION: To the best of our knowledge, this is the first randomized study to simultaneously compare the effects of surgical and non-surgical weight loss on changes in telomere length. It could provide a solution to the growing problem of metabolic syndrome. Normalization of the body mass index results in improvements in the health of patients with metabolic syndrome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03667469 . Registered on 11 September 2018.


Assuntos
Restrição Calórica , Dieta Redutora , Derivação Gástrica/métodos , Laparoscopia , Expectativa de Vida , Síndrome Metabólica/terapia , Obesidade/terapia , Perda de Peso , Adolescente , Adulto , Índice de Massa Corporal , Restrição Calórica/efeitos adversos , Comorbidade , Dieta Redutora/efeitos adversos , Feminino , Derivação Gástrica/efeitos adversos , Humanos , Cazaquistão , Laparoscopia/efeitos adversos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Homeostase do Telômero , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Acta Diabetol ; 56(7): 741-748, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993529

RESUMO

AIMS: Metabolic surgery is considered as a therapeutic option for obese patients with type 2 diabetes (T2D). In order to identify novel laboratory variables that could improve the selection of patients who might greatly benefit from a surgical approach, we focused on the neutrophil-to-lymphocyte ratio (NLR) as a predictor of long-term T2D remission following metabolic surgery. METHODS: Thirty-one obese patients with T2D included in this pilot study underwent Roux-en-Y gastric bypass or biliopancreatic diversion (BPD) at the Surgical Department of Genoa University, IRCCS Ospedale Policlinico San Martino in Genoa (Italy). Before surgery, serum samples were collected to evaluate blood count, glycemic profile, and circulating neutrophil degranulation products. RESULTS: The median age was 56 years, median body mass index (BMI) was 32.37 kg/m2, and median glycated hemoglobin was 8.4%. White blood cell count was in a range of normality, with a median NLR of 1.97. By a receiver operating characteristic curve analysis, NLR has been found to be significantly associated with T2D remission at 1, 3, and 5 years and the best cutoff of ≤ 1.97 has been identified by Youden index. When comparing study groups according to NLR cutoff, those with NLR ≤ 1.97 were older and underwent more often BPD. By a logistic regression analysis, NLR ≤ 1.97 has been found to predict T2D remission across 5 years, irrespective of baseline BMI. CONCLUSIONS: A baseline low NLR is associated with long-term T2D remission in obese patients undergoing metabolic surgery, suggesting that circulating inflammatory cells (i.e., neutrophils) might negatively impact on T2D remission.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/cirurgia , Linfócitos/patologia , Neutrófilos/patologia , Glicemia/metabolismo , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Hemoglobina A Glicada/metabolismo , Humanos , Itália , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/cirurgia , Projetos Piloto , Prognóstico , Indução de Remissão , Fatores de Tempo , Resultado do Tratamento
16.
Diab Vasc Dis Res ; 16(2): 144-152, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31014098

RESUMO

BACKGROUND: Reaven originally described the clustering of insulin resistance/hyperinsulinaemia, obesity (particularly visceral), altered cytokine levels, glucose intolerance, hypertriglyceridaemia and low high-density lipoprotein cholesterol. Subsequently, a potentially highly atherogenic small, dense low-density lipoprotein was also reported. We have studied the effect of bariatric surgery on this and other risk factors for atherosclerosis. METHODS: Forty patients (20 with type 2 diabetes mellitus) undergoing bariatric surgery were studied before and 1 year after bariatric surgery. RESULTS: Twelve months after bariatric surgery, median body mass index had decreased from 49.5 to 36.5 kg/m2, fasting insulin from 21.3 to 7.8 mU/L and insulin resistance (homeostatic model assessment of insulin resistance) from 5.9 to 1.8 (all p < 0.001). Thirteen out of 20 patients had remission from type 2 diabetes mellitus. Highly sensitive C-reactive protein, interleukin-6, fasting triglycerides ( p < 0.001) and small, dense low-density lipoprotein ( p < 0.001) decreased, while high-density lipoprotein cholesterol increased ( p < 0.001) significantly, irrespective of having type 2 diabetes mellitus and/or being treated with statin therapy before surgery. CONCLUSION: The association between marked weight loss and change in insulin resistance and hyperinsulinaemia with the change in small, dense low-density lipoprotein and interleukin-6 warrants further investigation. Bariatric surgery provides a model for investigating the mechanisms linking insulin resistance/hyperinsulinaemia to atherosclerosis.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Derivação Gástrica/métodos , Resistência à Insulina , Interleucina-6/sangue , Laparoscopia , Lipoproteínas LDL/sangue , Modelos Biológicos , Obesidade/cirurgia , Perda de Peso , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/fisiopatologia , Tamanho da Partícula , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Lipids Health Dis ; 18(1): 94, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967146

RESUMO

BACKGROUND: Obesity, widely recognized as a serious health concern, is characterized by profoundly altered metabolism. However, the intermediate metabolites involved in this change remain largely unknown. OBJECTIVE: We conducted targeted metabolomics profiling to identify moieties associated with adult obesity. METHODS: In this case-control study of Iranian adults, 200 obese patients were compared with 100 controls based on 104 metabolites profiled by a targeted metabolomic approach using liquid chromatography coupled to triple quadrupole mass spectrometry (LC-MS/MS). The analysis comprised acylcarnitines, diacyl-phosphatidylcholines (PCaa), acyl-alkyl-phosphatidylcholines (PCae), sphingomyelins (SM), lyso-phospholipids (LPC) and amino acids. We performed multivariable linear regression to identify metabolites associated with obesity, adjusting for age, sex, total energy intake, total physical activity, smoking, and alcohol consumption. The Bonferroni correction was used to adjust for multiple testing. RESULTS: A pattern of 19 metabolites was significantly associated with obesity. Branched chain amino acids, alanine, glutamic acid, proline, tyrosine LPCa C16:1, PCaa C32:1, PCaa C32:2 and PCaa C38:3 were positively, while serine, asparagine, LPCa C18:1, LPCa C18:2, LPCe C18:0, PCae C34:3, PCae C38:4 and PCae C40:6 were negatively associated with obesity (all p < 0.00048). CONCLUSIONS: A metabolomic profile containing 9 amino acids and 10 polar lipids may serve as a potential biomarker of adult obesity. Further studies are warranted to replicate these findings as well as investigate potential changes in this profile after weight reduction.


Assuntos
Aminoácidos/sangue , Carnitina/análogos & derivados , Lisofosfolipídeos/sangue , Obesidade/sangue , Fosfatidilcolinas/sangue , Esfingomielinas/sangue , Adulto , Consumo de Bebidas Alcoólicas/fisiopatologia , Aminoácidos/classificação , Biomarcadores/sangue , Índice de Massa Corporal , Carnitina/sangue , Estudos de Casos e Controles , Cromatografia Líquida , Exercício , Feminino , Humanos , Irã (Geográfico) , Modelos Lineares , Lisofosfolipídeos/classificação , Masculino , Metaboloma , Metabolômica/métodos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Fosfatidilcolinas/classificação , Fumar/fisiopatologia , Esfingomielinas/classificação , Espectrometria de Massas em Tandem
18.
Lipids Health Dis ; 18(1): 97, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975133

RESUMO

BACKGROUND: Evidence shows that low serum vitamin D concentrations account for an increased risk of obesity by inducing vitamin D receptor (VDR) hypofunction. Although the correlation between single nucleotide polymorphisms (SNPs) of VDR gene and obesity-related anthropometric measures (such as body mass index [BMI] and waist circumference[WC]) has already been tested, there are only few studies on the association between direct measures of body fat percentage (BFP) and triceps skinfold thickness and the SNPs of VDR. The aim of the present study was to evaluate the effect of VDR gene polymorphism on multiple obesity indexes in Han Chinese, including BMI, WC, BFP and triceps skinfold thickness. METHODS: In this cross-sectional study, five hundred and seventeen healthy Chinese adults were enrolled in the trial. Four loci in VDR gene (rs2228570 [FokI], rs2189480, rs2239179 and rs7975232[ApaI]) were genotyped by TaqMan probe assays. Obesity indexes including BMI, WC, BFP and triceps skinfold thickness were used to evaluate the relationship to the VDR SNPs. Multiple logistic regression, linear regression and general multifactor dimensionality reduction (GMDR) were performed to analyze the correlation of VDR gene and obesity indexes. RESULTS: None of the VDR SNPs were associated with BMI and WC, the C allele of FokI and the T allele of ApaI were associated with an increase in BFP (ß = 0.069,P = 0.007; ß = 0.087, P = 0.022 respectively); the G allele of rs2239179 and the T allele of ApaI were associated with an increase in triceps skin fold thickness (ß = 0.074, P = 0.001; ß = 0.122, P < 0.001 respectively). In regards to adiposity-related metabolic parameters, we found that the GT genotype of ApaI was associated with higher level of total cholesterol (TC) (P = 0.013) and Low-density lipoprotein cholesterol (LDL-C) (P = 0.001). CONCLUSIONS: Though we failed to prove that VDR SNPs were in correlation with BMI and WC, we did establish the association between VDR variants and BFP, as well as triceps skinfold thickness. Data obtained suggested that the VDR variants play an important role in regulating adipose tissue activity and adiposity among Han Chinese.


Assuntos
Tecido Adiposo/metabolismo , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Receptores de Calcitriol/genética , Pregas Cutâneas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Índice de Massa Corporal , China/epidemiologia , LDL-Colesterol/sangue , Estudos Transversais , Feminino , Expressão Gênica , Loci Gênicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Redução Dimensional com Múltiplos Fatores , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/epidemiologia , Receptores de Calcitriol/sangue , Circunferência da Cintura
19.
Clin Obes ; 9(3): e12303, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30816010

RESUMO

As the prevalence of obesity increases, the prevalence of associated comorbid diseases, obesity-related mortality rates and healthcare costs rise concordantly. Two main factors that hinder efforts to treat obesity include a lack of recognition by patients and documentation by physicians. This study evaluates the relationship between patient perception of obese weight and physician documentation of obesity. This quality improvement observational study surveyed patients of an academic internal medicine clinic on their perception of obesity. Responses were compared to longitudinal physician documentation of obesity and body mass index (BMI). A total of 59.9% of patients with obesity perceived their weight as obese. While 33.7% of patients with a BMI of 30 to 34.9 kg/m2 perceived themselves as having obesity, 71.4% of patients with a BMI of 45 to 49.9 kg/m2 perceived themselves as having obesity. A total of 42.4% of patients with obesity had physician documentation of obesity in the last year. While 25% of patients with a BMI of 30 to 34.9 kg/m2 had physician documentation of obesity, 85.7% of patients with a BMI of 45 to 49.9 kg/m2 had physician documentation of obesity. For patients with a BMI ≥50 kg/m2 , 52.9% perceived their weight to be obese and 76.5% had physician documentation of obesity in the last year. Both patient perception and physician documentation of obesity were significantly less than the prevalence of obesity. Patient perception of obesity and provider documentation of obesity increased as BMI increased until a BMI ≥50 kg/m2 . Both patients and providers must improve recognition of this disease.


Assuntos
Obesidade/psicologia , Pacientes/estatística & dados numéricos , Percepção , Médicos/estatística & dados numéricos , Adulto , Idoso , Índice de Massa Corporal , Documentação , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Obesidade/diagnóstico , Médicos/psicologia , Médicos/normas , Melhoria de Qualidade , Inquéritos e Questionários
20.
Nat Rev Endocrinol ; 15(5): 288-298, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30814686

RESUMO

The prevalence of obesity has increased worldwide in the past ~50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as type 2 diabetes mellitus, fatty liver disease, hypertension, myocardial infarction, stroke, dementia, osteoarthritis, obstructive sleep apnoea and several cancers, thereby contributing to a decline in both quality of life and life expectancy. Obesity is also associated with unemployment, social disadvantages and reduced socio-economic productivity, thus increasingly creating an economic burden. Thus far, obesity prevention and treatment strategies - both at the individual and population level - have not been successful in the long term. Lifestyle and behavioural interventions aimed at reducing calorie intake and increasing energy expenditure have limited effectiveness because complex and persistent hormonal, metabolic and neurochemical adaptations defend against weight loss and promote weight regain. Reducing the obesity burden requires approaches that combine individual interventions with changes in the environment and society. Therefore, a better understanding of the remarkable regional differences in obesity prevalence and trends might help to identify societal causes of obesity and provide guidance on which are the most promising intervention strategies.


Assuntos
Saúde Global , Estilo de Vida , Obesidade/epidemiologia , Comportamento Sedentário , Ingestão de Energia/fisiologia , Metabolismo Energético/fisiologia , Humanos , Obesidade/diagnóstico , Obesidade/metabolismo , Organização Mundial da Saúde
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