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1.
; IBFAN.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46900

RESUMO

Durante o XV Encontro Nacional de Aleitamento Materno (ENAM), especialistas alertam da importância de combater a obesidade infantil e adulta através da amamentação exclusiva até os seis meses. Um estudo realizado pela Organização Mundial da Saúde revelou que crianças alimentadas exclusivamente com leite materno no primeiro semestre de vida tinham risco 25% menor de obesidade. Além disso, o estudo cita uma pesquisa que revela que cada mês adicional de amamentação estava associado a uma redução de 4% na prevalência de sobrepeso.


Assuntos
Aleitamento Materno , Sobrepeso , Obesidade Pediátrica , Obesidade/prevenção & controle , Saúde da Criança , Promoção da Saúde
2.
BMJ ; 367: l5837, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666218

RESUMO

OBJECTIVE: To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction. DESIGN: Quasi-experimental longitudinal study. SETTING: Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018. PARTICIPANTS: 104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period. MAIN OUTCOME MEASURES: Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census). RESULTS: The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81). CONCLUSIONS: A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.


Assuntos
Ingestão de Energia/fisiologia , Fast Foods/efeitos adversos , Rotulagem de Alimentos , Obesidade/prevenção & controle , Restaurantes/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Dieta Saudável , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Ensaios Clínicos Controlados não Aleatórios como Assunto , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Sudeste dos Estados Unidos/epidemiologia
3.
Rev Lat Am Enfermagem ; 27: e3177, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596412

RESUMO

OBJECTIVE: analyze associations between demographic, academic, health, stress, overweight and obesity characteristics among nursing students. METHOD: this is a cross-sectional study with 95 students from a private university in Rio Grande do Sul, Brazil. A demographic, academic and health characterization questionnaire and the Assessment of Stress in Nursing Students (ASNS) scale were applied. Anthropometric measures were taken and descriptive and bivariate analyses were performed. RESULTS: female students predominated in this study, mean age: 25.6±5.87 years. Weight gain was observed in 52.6% of the students, with the 'Professional training' session reporting high (29.5%) and very high (36.8%) levels of stress. None of the stress scale sessions was associated with overweight and obesity. CONCLUSION: overweight and obesity were associated with male participants, high blood pressure, weight gain since the beginning of the course, altered waist circumference, no physical activity, eating more in stressful situations, and consumption of unhealthy foods.


Assuntos
Sobrepeso/psicologia , Estresse Psicológico/epidemiologia , Estudantes de Enfermagem/psicologia , Adulto , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/prevenção & controle , Obesidade/psicologia , Sobrepeso/prevenção & controle , Circunferência da Cintura
4.
Int J Gynaecol Obstet ; 147(2): 131-133, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31571231

RESUMO

The activities of the FIGO Pregnancy Obesity and Nutrition Initiative are aimed at reducing all types of malnutrition in women before, during and after pregnancy.


Assuntos
Programas de Rastreamento/métodos , Obesidade/prevenção & controle , Fenômenos Fisiológicos da Nutrição Pré-Natal , Feminino , Humanos , Gravidez
5.
BMJ ; 366: l4786, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484641

RESUMO

OBJECTIVE: To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN: Modelling study. SETTING: General adult population of the United Kingdom. PARTICIPANTS: 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES: The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS: For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS: Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.


Assuntos
Comércio , Obesidade/epidemiologia , Lanches , Açúcares/efeitos adversos , Impostos , Adolescente , Adulto , Índice de Massa Corporal , Ingestão de Energia , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Modelos Biológicos , Modelos Econômicos , Obesidade/etiologia , Obesidade/prevenção & controle , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 875-884, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474067

RESUMO

With the rapid economic development and dramatic changes in lifestyle, the prevalence of overweight and obesity in China has been increasing significantly and become a serious public health threat. This article introduced the main contents of "China Blue Paper on Obesity Prevention and Control", aiming to facilitate understanding and applications of the "China Blue Paper on Obesity Prevention and Control" by policymakers, researchers and practitioners in related fields. Built upon these, recommendations were made for obesity screening, diagnosis, treatment and management, prevention and control policies and strategies, and future research priorities in China.


Assuntos
Política de Saúde , Obesidade , Sobrepeso , China/epidemiologia , Humanos , Estilo de Vida , Programas de Rastreamento , Obesidade/epidemiologia , Obesidade/prevenção & controle , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Prevalência
7.
Matern Child Health J ; 23(12): 1604-1612, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541375

RESUMO

INTRODUCTION: Nearly half of all women gain above gestational weight gain (GWG) recommendations. This study assessed the feasibility and efficacy of a pilot behavioral intervention on GWG and physical activity behaviors. METHODS: Women (n = 45) 14-20 weeks gestation enrolled in a behavioral intervention. Physicians 'prescribed' the intervention to low risk patients. The intervention included self-monitoring, support, and optional walking groups. Process evaluation measures regarding usage and acceptability of study components were obtained. Physical activity was objectively measured at baseline and 35 weeks. The percentage of participants with appropriate GWG was calculated. Control data was obtained from the same clinic where participants were recruited. RESULTS: Overall, the intervention was acceptable to participants; attrition was low (6.7%), weekly contact was high (87%), and self-monitoring was high (Fitbit worn on 82% of intervention weeks; weekly weighing on 81%). Facebook (40% of weeks) and study website use (19%) was low, as was walking group attendance (7% attended a single group). Participants reported a lack of discussions about the study with their physician. Results showed no significant difference between intervention and control participants in the percentage who gained excess weight (p = 0.37). There was a significant decrease in moderate-to-vigorous physical activity in intervention participants (p < 0.0001). DISCUSSION: Continued efforts for promoting physical activity and appropriate GWG are needed. Although acceptable, the intervention was not efficacious. Trainings for, or input from prenatal healthcare providers on how to best encourage and support patients' engagement in healthy behaviors, such as PA, are warranted.


Assuntos
Terapia Comportamental/métodos , Exercício , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Obesidade/prevenção & controle , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Obesidade/terapia , Projetos Piloto , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Saúde Pública , Fatores de Risco , Ganho de Peso , Adulto Jovem
8.
Ther Umsch ; 76(3): 111-116, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31498044

RESUMO

Health effects of sugar consumption and possible alternatives Abstract. A wide range of chronic diseases is associated with sugar consumption: Caries, obesity, metabolic syndrome with impaired glucose tolerance and / or diabetes, elevated blood, lipids arterial, hypertension, hepatic steatosis and cardiovascular morbidity and mortality. There is an urgent need to reduce sugar consumption. Sugar surrogates may help achieving this goal. However, artificial sweeteners seem to be associated with adverse metabolic effects such as insulin resistance, obesity, and altered gut microbiota composition. Naturally occurring sweeteners such as xylitol, erythritol and rare sugars are possibly more favorable, but have to be studied in detail.


Assuntos
Diabetes Mellitus , Açúcares/administração & dosagem , Açúcares/efeitos adversos , Edulcorantes/administração & dosagem , Diabetes Mellitus/prevenção & controle , Humanos , Resistência à Insulina , Obesidade/etiologia , Obesidade/prevenção & controle , Edulcorantes/efeitos adversos
9.
Cochrane Database Syst Rev ; 9: CD012099, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529625

RESUMO

BACKGROUND: Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant.Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long-term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. OBJECTIVES: To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. SEARCH METHODS: On 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group. DATA COLLECTION AND ANALYSIS: We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster-RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high-income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias.Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low-certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non-initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum.Multiple methods of breastfeeding support versus usual care Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face-to-face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest.We are unclear about the effects of the intervention because we identified very low-certainty evidence for all of the important outcomes in this review: rate of non-initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women).The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low-certainty evidence means that we are unclear about the effects of the intervention on those outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low-certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups.Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.


Assuntos
Aleitamento Materno/psicologia , Promoção da Saúde/métodos , Mães/psicologia , Obesidade , Sobrepeso , Feminino , Humanos , Lactente , Mães/educação , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Período Pós-Parto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
10.
Aust N Z J Public Health ; 43(5): 484-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31390112

RESUMO

OBJECTIVE: The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. METHODS: A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to identify, screen and report on eligible studies. RESULTS: Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to individual risk factors were between $840 million and $14.9 billion for obesity; up to $10.5 billion due to tobacco; between $1.1 billion and $6.8 billion for excess alcohol consumption; up to $15.6 billion due to physical inactivity and $561 million for individual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. CONCLUSIONS: Substantial economic burden is caused by lifestyle-related risk factors. Implications for public health: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.


Assuntos
Alcoolismo/economia , Doença Crônica/economia , Doença Crônica/prevenção & controle , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Doenças não Transmissíveis/economia , Obesidade/economia , Obesidade/prevenção & controle , Comportamento Sedentário , Fumar/economia , Alcoolismo/terapia , Austrália/epidemiologia , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Humanos , Estilo de Vida , Doenças não Transmissíveis/terapia , Obesidade/epidemiologia , Fumar/efeitos adversos
12.
Adv Exp Med Biol ; 1121: 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31392650

RESUMO

The origin of some non communicable disease (NCDs) is in early life. Evidence has shown that early life nutrition is associated with the risk of developing chronic non communicable diseases. Pregnancy and infancy are the most critical stages that influence the risks of NCDs in childhood and adult life. Prenatal maternal undernutrition and low birth weight lead to obesity and increase the risk factors of cardiovascular disease and diabetes later in life. Nutrition is one of the easily modifiable environmental factors that may affect outcome of pregnancy, trajectory of growth, and immune system of the fetus and infant. Healthy eating behaviors associate with prevention of weight disorders in pediatric, non communicable diseases, and deficiencies of micronutrient.


Assuntos
Comportamento Alimentar , Doenças não Transmissíveis , Fenômenos Fisiológicos da Nutrição , Adulto , Doenças Cardiovasculares/prevenção & controle , Criança , Feminino , Humanos , Lactente , Obesidade/prevenção & controle , Gravidez
13.
Cochrane Database Syst Rev ; 7: CD011972, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31309536

RESUMO

BACKGROUND: Psoriasis is an inflammatory skin disease that presents with itching, red, scaling plaques; its worsening has been associated with obesity, drinking, smoking, lack of sleep, and a sedentary lifestyle. Lifestyle changes may improve psoriasis. OBJECTIVES: To assess the effects of lifestyle changes for psoriasis, including weight reduction, alcohol abstinence, smoking cessation, dietary modification, exercise, and other lifestyle change interventions. SEARCH METHODS: We searched the following databases up to July 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched the China National Knowledge Infrastructure, the Airiti Library, and five trials registers up to July 2018. We checked the references of included trials for further relevant trials, and we asked the authors of the included trials if they were aware of any relevant unpublished data. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of lifestyle changes (either alone or in combination) for treating psoriasis in people diagnosed by a healthcare professional. Treatment had to be given for at least 12 weeks. Eligible comparisons were no lifestyle changes or another active intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Severity of psoriasis' and 'Adherence to the intervention'. Secondary outcomes were 'Quality of life', 'Time to relapse', and 'Reduction in comorbidities'. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS: We included 10 RCTs with 1163 participants (mean age: 43 to 61 years; 656 men and 478 women were reported). Six trials examined the effects of dietary intervention (low-calorie diet) in 499 obese participants (mean age: 44.3 to 61 years; where reported, 395 had moderate-to-severe psoriasis). One trial assessed a combined dietary intervention and exercise programme in 303 obese participants with moderate-to-severe psoriasis who had started a systemic therapy for psoriasis and had not achieved clearance after four weeks of continuous treatment (median age: 53 years). Another trial assessed a walking exercise and continuous health education in 200 participants (mean age: 43.1 years, severity not reported). Finally, two trials included education programmes promoting a healthy lifestyle in 161 participants (aged 18 to 78 years), with one trial on mild psoriasis and the other trial not reporting severity.Comparisons included information only; no intervention; medical therapy alone; and usual care (such as continuing healthy eating).All trials were conducted in hospitals and treated participants for between 12 weeks and three years. One trial did not report the treatment period. Seven trials measured the outcomes at the end of treatment and there was no additional follow-up. In two trials, there was follow-up after the treatment ended. Five trials had a high risk of performance bias, and four trials had a high risk of attrition bias.We found no trials assessing interventions for alcohol abstinence or smoking cessation. No trials assessed time to relapse. Only two trials assessed adverse events; in one trial these were caused by the add-on therapy ciclosporin (given in both groups). The trial comparing two dietary interventions to a no-treatment group observed no adverse events.The results presented in this abstract are based on trials of obese participants.Outcomes for dietary interventions versus usual care were measured 24 weeks to six months from baseline. Compared to usual care, dietary intervention (strict caloric restriction) may lead to 75% or greater improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.07 to 2.58; 2 trials, 323 participants; low-quality evidence). Adherence to the intervention may be greater with the dietary intervention than usual care, but the 95% CI indicates that the dietary intervention might also make little or no difference (RR 1.26, 95% CI 0.76 to 2.09; 2 trials, 105 participants; low-quality evidence). Dietary intervention probably achieves a greater improvement in dermatology quality-of-life index (DLQI) score compared to usual care (MD -12.20, 95% CI -13.92 to -10.48; 1 trial, 36 participants; moderate-quality evidence), and probably reduces the BMI compared to usual care (MD -4.65, 95% CI -5.93 to -3.36; 2 trials, 78 participants; moderate-quality evidence).Outcomes for dietary interventions plus exercise programme were measured 16 weeks from baseline and are based on one trial (303 participants). Compared to information only (on reducing weight to improve psoriasis), combined dietary intervention and exercise programme (dietetic plan and physical activities) probably improves psoriasis severity, but the 95% CI indicates that the intervention might make little or no difference (PASI 75: RR 1.28, 95% CI 0.83 to 1.98). This combined intervention probably results in a greater reduction in BMI (median change -1.10 kg/m², P = 0.002), but there is probably no difference in adherence (RR 0.95, 95% CI 0.89 to 1.01; 137/151 and 145/152 participants adhered in the treatment and control group, respectively). There were no data on quality of life. These outcomes are based on moderate-quality evidence. AUTHORS' CONCLUSIONS: Dietary intervention may reduce the severity of psoriasis (low-quality evidence) and probably improves quality of life and reduces BMI (moderate-quality evidence) in obese people when compared with usual care, while combined dietary intervention and exercise programme probably improves psoriasis severity and BMI when compared with information only (moderate-quality evidence). None of the trials measured quality of life.We did not detect a clear difference in treatment adherence between those in the combined dietary intervention and exercise programme group and those given information only (moderate-quality evidence). Adherence may be improved through dietary intervention compared with usual care (low-quality evidence). Participants generally adhered well to the lifestyle interventions assessed in the review.No trials assessed the time to relapse. Trial limitations included unblinded participants and high dropout rate.Future trials should reduce dropouts and include comprehensive outcome measures; they should examine whether dietary intervention with or without an exercise programme is effective in non-obese people with psoriasis, whether an additional exercise programme is more effective than dietary intervention alone, whether the time to relapse prolongs in people who receive dietary intervention with or without exercise programme, and whether smoking cessation and alcohol abstinence are effective in treating psoriasis.


Assuntos
Exercício/fisiologia , Estilo de Vida , Psoríase/terapia , Qualidade de Vida , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/prevenção & controle , Prurido/prevenção & controle , Prurido/terapia , Psoríase/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Caminhada , Adulto Jovem
14.
Life Sci ; 232: 116672, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31336120

RESUMO

AIMS: Obesity is not only associated with metabolic diseases but is also a symptom of menopause in women. To date, there are no effective drugs for the management of obesity, and it is important to find new agents with fewer side effects, for the treatment of obesity. This study aimed to determine the anti-obesity effect of 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17-DMAG), a heat shock protein 90 (Hsp90) inhibitor, and its underlying mechanism in rats with ovariectomy-induced obesity. MAIN METHODS: Ovariectomy (Ovx) rats were treated with 17-DMAG (1 mg kg-1, intraperitoneally) for eight weeks from one week after surgery. The body weight, food intake, locomotor activity, adipogenic- and autophagy-related protein expression in white adipose tissue (WAT) and plasma triglyceride (TG) levels were measured in sham and Ovx rats. KEY FINDINGS: Compared with sham rats, Ovx rats showed increased weight gain, food intake, WAT mass, TG levels, adipogenic protein expression, and decreased locomotor activity. Furthermore, autophagy-related proteins and Foxo3a of WAT were significantly increased in Ovx rats. However, with the exclusion of increased food intake, the changes induced by Ovx were all reversed in 17-DMAG-treated Ovx rats. In addition, the expression of Hsp70 and phosphorylation of Akt increased in 17-DMAG-treated Ovx rats. SIGNIFICANCE: These results suggest that 17-DMAG significantly ameliorated obesity induced by Ovx, and this phenomenon is accompanied by the downregulation of adipogenic-related and autophagy-related proteins as well as the upregulation of Akt-phosphorylation and Hsp70 expression. Therefore, 17-DMAG may be a potential agent for preventing or treating obesity in postmenopausal women.


Assuntos
Benzoquinonas/farmacologia , Proteínas de Choque Térmico HSP90/antagonistas & inibidores , Lactamas Macrocíclicas/farmacologia , Obesidade/etiologia , Obesidade/prevenção & controle , Ovariectomia/efeitos adversos , Adipogenia , Tecido Adiposo/metabolismo , Animais , Autofagia , Ingestão de Alimentos/efeitos dos fármacos , Feminino , Proteínas de Choque Térmico HSP90/metabolismo , Locomoção/efeitos dos fármacos , Ratos
15.
J Stroke Cerebrovasc Dis ; 28(9): 2543-2554, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296475

RESUMO

BACKGROUND: Today there exists few intervention researches on cerebro-vascular function in populations at high risk of stroke in China. METHODS: Patients more than 40 years old, with at least 1 of stroke risk factors were recruited from outpatient department in 3 hospitals. A quasi-experimental design was performed by assigning participants into 3 groups: comprehensive intervention group, health education group, and control group. Participants in the control group received no intervention but were informed of risk factors of stroke. For health education group, a health education class was performed. Except to the health education program, participants in the comprehensive intervention group received an additional health life and behavior guidance. RESULTS: After the intervention, the Cerebro-Vascular Function Scores (CVFS) had significant differences among 3 groups (F = 5.252, P < 0.05). There was a significant increase in CVFS compared to the control group (P = 0.003, 95%CI: 1.552-8.493). Significantly changes in obesity were observed in comprehensive intervention group before and after the intervention (χ2 = 9.0747, P = 0.0026). The results of logistic regression showed that comprehensive intervention group had a significant decrease in prevalence of obesity (OR = 0.482, 95% CI: 0.242-0.961) compared to the control group. CONCLUSION: Health education on stroke in a high-risk population combined with guidance on proper health life and behavior can be effective in preventing stroke.


Assuntos
Circulação Cerebrovascular , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/métodos , Serviços Preventivos de Saúde/métodos , Comportamento de Redução do Risco , Acidente Vascular Cerebral/prevenção & controle , Adulto , China/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/prevenção & controle , Prevalência , Fatores de Proteção , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento
16.
Aust N Z J Public Health ; 43(4): 328-333, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268219

RESUMO

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.


Assuntos
Exercício , Promoção da Saúde/organização & administração , Estilo de Vida Saudável , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sobrepeso/etnologia , Perda de Peso , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/prevenção & controle , Grupo com Ancestrais Oceânicos/psicologia , Sobrepeso/prevenção & controle , Programas de Redução de Peso , Adulto Jovem
17.
Pediatr Cardiol ; 40(6): 1113-1125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31342115

RESUMO

Pathology studies demonstrated that coronary fatty streaks develop early in life and that even more advanced fibrous plaques are present in a proportion of adolescents. The presence and extent of atherosclerosis in children and adolescents can be correlated with the same risk factors present in adults; as well as, childhood levels of these risk factors predict adult cardiovascular diseases. Children are born with ideal cardiovascular health but, unfortunately, most of them develop over time modifiable behavioral risk factors. Achieving sustained lifestyle changes initiated too late in adults is difficult, and pharmacologic risk factor control cannot fully restore a low-risk state. Therefore, it seems eminently reasonable to initiate healthful lifestyle training as early in life, decreasing the prevalence of cardiovascular risk factors to retard atherogenic processes and reduce the future burden of cardiovascular diseases. Many guideline recommendations encourage universal adoption of healthier lifestyles, identification of children with cardiovascular risk factors, and their treatment using targeted lifestyle modification and, rarely, pharmacotherapy. Major gains will likely accrue from public health strategies targeting incorrect diet, physical activity, and cigarette smoking. Individualized strategies, however, will initially focus on the highest risk children such as those with familial hyperlipidaemia, diabetes, hypertension, and obesity. The primary purpose of this article is to provide a broad overview on the long-term cardiovascular effects of risk factors in children and youth and to outline various lines of evidence for the efficacy of primordial and primary prevention in young people, as well as recommendations for population- and individual-level strategies and evidence-based interventions.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Exercício , Estilo de Vida Saudável , Prevenção Primária/métodos , Adolescente , Adulto , Aterosclerose/prevenção & controle , Doenças Cardiovasculares/etiologia , Criança , Diabetes Mellitus/prevenção & controle , Progressão da Doença , Humanos , Hipertensão/prevenção & controle , Obesidade/prevenção & controle , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco
18.
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
19.
BMC Health Serv Res ; 19(1): 453, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277640

RESUMO

BACKGROUND: Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. METHODS: Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. RESULTS: The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals' views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. CONCLUSIONS: This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.


Assuntos
Serviços de Saúde Comunitária , Promoção da Saúde , Obesidade/prevenção & controle , Adulto , Serviços de Saúde Comunitária/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Atenção Primária à Saúde
20.
Aust N Z J Public Health ; 43(4): 346-351, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31180614

RESUMO

OBJECTIVE: Price promotions are used to influence purchases and represent an important target for obesity prevention policy. However, no long-term contemporary data on the extent and frequency of supermarket price promotions exists. We aimed to evaluate the frequency, magnitude and weekly variation of beverage price promotions available online at two major Australian supermarket chains over 50 weeks. METHODS: Beverages were categorised into four policy-relevant categories (sugar-sweetened beverages, artificially-sweetened beverages, flavoured milk and 100% juice, milk and water). The proportional contribution of each category to the total number of price proportions, the proportion of price promotions within the available product category, the mean discount, and weekly variation in price promotions were calculated. RESULTS: For Coles and Woolworths respectively, 26% and 30% of all beverages were price promoted in any given week. Sugar-sweetened beverages made up the greatest proportion of all price promotions (Coles: 46%, Woolworths: 49%). Within each product category, the proportion of sugar-sweetened and artificially-sweetened beverages that were price promoted was similar, higher than the other categories and reasonably constant over time. Diet drinks and sugar-sweetened soft drinks were most heavily discounted (by 29-40%). CONCLUSIONS: Beverage price promotions are used extensively in Australian supermarkets, undermining efforts to promote healthy population diets. Implications for public health: Policies restricting price promotions on sugar-sweetened beverages are likely to be an important part of strategies to reduce obesity and improve population nutrition.


Assuntos
Publicidade como Assunto/métodos , Bebidas/economia , Bebidas/provisão & distribução , Comércio/economia , Austrália , Bebidas Gaseificadas , Humanos , Obesidade/prevenção & controle
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