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1.
Z Psychosom Med Psychother ; 65(3): 224-238, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476994

RESUMO

App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program Objective: Are three app-controlled feedback devices, tested against a simple pedometer in a weight reduction program, supporting sustainable therapy success and quality of life (QoL)? Methods: In this multi-centre randomised controlled study adults with obesity (n = 89, m = 46.5 years, women n = 54), achieved high weight loss (from 42.7 kg/m² to 35.2 kg/m²) while completing the first three month of the OPTIFAST®52-program. Thereafter the intervention group (IG) used feedback devices (BIA scale, blood pressure monitor, step counter), the control group a mechanical pedometer without app for another year. Intention-to-treat analysis (ITT) and As-treated analysis (AT) were carried out. Results: Feedback devices had a positive effect on fat-loss and secondary study objectives like QoL, leading to a better sustainability of these improvements. Participants in IG (AT for t2-t0) had improvements for Waist-to-Height-ratio (WHtR) and physically and mentally quality of life. Conclusion: The results are presumably based on an increase in self-efficacy and the experience of control. Future studies should be preceded by a pilot study to analyse acceptance problems.


Assuntos
Manutenção do Peso Corporal , Retroalimentação , Aplicativos Móveis , Obesidade/terapia , Qualidade de Vida , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 98(33): e16815, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415397

RESUMO

BACKGROUND: Acupuncture is effective for reducing body weight; however, evidence in Asian populations is lacking. We performed a systematic review and meta-analysis to evaluate the efficacy of acupuncture for body weight reduction in Asians. METHODS: The Medline, Embase, Cochrane library, and Chinese databases were searched for relevant studies through October 20, 2018. Publications describing randomized controlled trials (RCTs) comparing acupuncture with other treatments for the reduction of body weight were compiled. Reviewers assessed bias and collected data on trial characteristics and outcomes. The study was conducted based on the reporting items of the guidelines for systematic evaluation and meta-analysis (PRISMA). Review Manager 5.2 software was used to calculate weight mean difference (WMD) and 95% confidence intervals (CIs). RESULTS: Twelve RCTs involving 1151 subjects were included. Compared with the control groups, the acupuncture groups exhibited significantly greater reductions of body mass index (BMI) (WMD -1.23 kg/m; 95% CI -1.94, -0.51) and waist circumference (WMD -2.56 cm; 95% CI -4.43, -0.69). In the subgroup analyses, significant differences in the reduction of BMI and the reduction of waist circumference were observed between the acupuncture and sham acupuncture groups, the acupuncture plus diet and exercise, and the diet and exercise groups, and the acupuncture and no intervention groups, but not between the acupuncture plus exercise and exercise groups. CONCLUSIONS: Our study demonstrates that acupuncture is effective in the intervention of overweight/obesity in Asians; however, compared with exercise alone, acupuncture combined with exercise had no effect on the BMI or waist circumstance in the short term. Long-term studies are needed to evaluate the efficacy of acupuncture in weight reduction in Asians.


Assuntos
Terapia por Acupuntura/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Terapia por Exercício/estatística & dados numéricos , Obesidade/terapia , Sobrepeso/terapia , Terapia por Acupuntura/métodos , Adulto , Índice de Massa Corporal , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Sobrepeso/etnologia , Resultado do Tratamento , Perda de Peso
3.
Medicine (Baltimore) ; 98(34): e16959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441898

RESUMO

BACKGROUND: Overweight and obesity characterized by abnormal or excessive fat accumulation, can cause many complications. Auriculotherapy, as the traditional Chinese technique, is widely applied in clinical trials for the management of body weight. The program aims to evaluate the effect and safety of auriculotherapy therapy and intervention types on weight control. METHODS: All randomized controlled trials related to auriculotherapy targeting overweight and obesity will be searched in online databases, such as Medline, EMbase, Cochrane Central Register of Controlled Trials, AMED, CBM, Wanfang Data, and other databases from their inception to July 2019. The primary outcome is the difference in BMI from baseline to the end of studies. Secondary outcomes include the change of weight, percentage of body fat, waist circumference, serum lipid before and after treatment. Study selection, data extraction, and assessment of risk of bias will be performed independently by 2 reviewers. Comprehensive Meta-Analysis software (Version 3; Biostat Inc.) will be used for data synthesis. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of obesity with auriculotherapy. CONCLUSION: The conclusion of this study will provide evidence to judge whether auriculotherapy is an effective therapeutic intervention for obesity. PROSPERO REGISTRATION NUMBER: CRD42019136827.


Assuntos
Auriculoterapia/métodos , Obesidade/terapia , Humanos , Medicina Tradicional Chinesa , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisão Sistemática como Assunto
4.
Postgrad Med ; 131(5): 357-365, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155994

RESUMO

Objective: Our aim was to explore how differing attitudes, expectations, and experiences among people with obesity (PwO) and healthcare providers (HCPs) might have an impact on effectively implementing current obesity treatment guidelines. Methods: Online surveys were conducted among 3,008 adult PwO (BMI≥30 by self-reported height and weight) and 606 HCPs. Results: PwO with weight loss ≥ 10% during the previous three years were more likely to have been diagnosed with obesity and to have discussed a weight loss plan with an HCP. However, only 21% believe HCPs have a responsibility to actively contribute to their obesity treatment. Further, HCPs tend not to effectively communicate the diagnosis of obesity, its nature as a serious and chronic disease, the full range of treatment options, and obesity's implications for health and quality of life. Regarding treatment goals, HCPs more often focus on BMI reduction, while PwO's goals focus on improved functioning, energy, and appearance. HCPs also tend to underestimate their patients' motivation to address their obesity. Twenty-eight percent of HCPs 'completely agreed' that losing weight was a high priority for PwO, whereas more than half of PwO 'completely agreed' that losing weight was a high priority for them. When asked how their HCP could better support them, PwO most often expressed a desire for helpful resources, as well as assistance with specific and realistic goal-setting to improve health. Conclusions: HCPs can more effectively implement obesity treatment guidelines by more clearly and proactively communicating with PwO about their diagnosis, health implications of obesity, desired treatment goals, and the full range of treatment options. HCPs should understand that most PwO believe that managing their disease is solely their own responsibility. HCPs can also encourage more effective conversations by better appreciating their patients' motivation and treatment goals.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Pessoal de Saúde/psicologia , Obesidade/patologia , Autorrelato , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Autogestão/psicologia , Apoio Social , Perda de Peso
6.
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
7.
BMC Public Health ; 19(1): 816, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234818

RESUMO

BACKGROUND: Adherence to weight loss interventions is crucial to successful outcomes, yet little is known about how best to improve it. This suggests a need for developing and improving adherence strategies, such as formal commitments. This review aims to identify the effect of including a commitment device alongside lifestyle interventions on weight loss, and identify the most appropriate delivery mechanisms and target behaviours. METHODS: We searched five databases and hand-searched reference lists for trials of behavioural interventions to achieve weight loss among adults with excess weight or obesity. Interventions incorporating commitment devices were included in a narrative review and meta-analysis where appropriate. Commitment devices with financial incentives were excluded. RESULTS: Of 2675 unique studies, ten met the inclusion criteria. Data from three randomised trials including 409 participants suggests that commitment interventions increases short-term weight loss by a mean of 1.5 kg (95% CI: 0.7, 2.4). Data from two randomised trials including 302 patients suggests that benefits were sustained at 12 months (mean difference 1.7 kg; 95% CI: 0.0, 3.4). Commitment devices appeared most successful when made publicly, and targeting diet rather than physical activity. CONCLUSIONS: Using commitment devices, such as behavioural contracts, as part of a weight loss intervention may be useful in improving weight loss outcomes and dietary changes, at least in the short-term. However, evidence is limited and of variable quality so results must be interpreted with caution. Poor reporting of intervention details may have limited the number of identified studies. More rigorous methodology and longer term follow-ups are required to determine the effectiveness of behavioural contracts given their potential for use in public health interventions.


Assuntos
Terapia Comportamental , Obesidade/psicologia , Sobrepeso/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Programas de Redução de Peso , Adulto , Dieta/psicologia , Exercício/psicologia , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/terapia , Sobrepeso/terapia , Resultado do Tratamento , Perda de Peso
8.
Vasc Health Risk Manag ; 15: 89-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118651

RESUMO

Obesity is associated with an increased risk of developing cardiovascular disease (CVD), particularly heart failure (HF) and coronary heart disease (CHD). The mechanisms through which obesity increases CVD risk involve changes in body composition that can affect hemodynamics and alters heart structure. Pro-inflammatory cytokines produced by the adipose tissue itself which can induce cardiac dysfunction and can promote the formation of atherosclerotic plaques. When obesity and HF or CHD coexist, individuals with class I obesity present a more favorable prognosis compared to individuals who are normal or underweight. This phenomenon has been termed the "obesity paradox." Obesity is defined as an excess fat mass (FM), but individuals with obesity typically also present with an increased amount of lean mass (LM). The increase in LM may explain part of the obesity paradox as it is associated with improved cardiorespiratory fitness (CRF), a major determinant of clinical outcomes in the general population, but particularly in those with CVD, including HF. While increased LM is a stronger prognosticator in HF compared to FM, in patients with CHD excess FM can exert protective effects particularly when not associated with increased systemic inflammation. In the present review, we discuss the mechanisms through which obesity may increase the risk for CVD, and how it may exert protective effects in the setting of established CVD, with a focus on body composition. We also highlight the importance of measuring or estimating CRF, including body composition-adjusted measures of CRF (ie, lean peak oxygen consumption) for an improved risk status stratification in patients with CVD and finally, we discuss the potential non-pharmacologic therapeutics, such as exercise training and dietary interventions, aimed at improving CRF and perhaps clinical outcomes.


Assuntos
Composição Corporal , Doenças Cardiovasculares/epidemiologia , Hemodinâmica , Obesidade/epidemiologia , Aptidão Cardiorrespiratória , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Comorbidade , Exercício , Dieta Saudável , Humanos , Inflamação/sangue , Inflamação/epidemiologia , Mediadores da Inflamação/sangue , Estado Nutricional , Obesidade/sangue , Obesidade/fisiopatologia , Obesidade/terapia , Prognóstico , Fatores de Proteção , Fatores de Risco , Comportamento de Redução do Risco
9.
BMC Public Health ; 19(1): 596, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101037

RESUMO

BACKGROUND: For patients with obesity who are not ready for or experience barriers to weight loss, clinical practice guidelines recommend provider counseling on preventing further weight gain as a first-line treatment approach. Unfortunately, evidence-based weight gain prevention interventions are not routinely available within primary care. To address this gap, we will implement a pragmatic 12-month randomized controlled trial of a digital weight gain prevention intervention delivered to patients receiving primary care within a network of Federally Qualified Community Health Centers in central North Carolina. METHODS: Balance (Equilibrio in Spanish) is a pragmatic effectiveness trial that will randomize adult patients who have overweight or obesity (BMI of 25-40 kg/m2) to either: 1) a weight gain prevention intervention with tailored behavior change goals and tracking, daily weighing on a network-connected electronic scale, and responsive weight and goal coaching delivered remotely by health center registered dietitians; or 2) a usual care program with automated healthy living text messages and print materials and routine primary care. The primary outcome will be weight gain prevention at 24-months, defined as ≤3% change in baseline weight. To align with its pragmatic design, trial outcome data will be pulled from the electronic health record of the community health center network. DISCUSSION: For underserved, often rurally-located patients with obesity, digital approaches to promote a healthy lifestyle can curb further weight gain. Yet enrolling medically vulnerable patients into a weight gain prevention trial, many of whom are from racial/ethnic minorities, can be difficult. Despite these potential challenges, we plan to recruit a large, diverse sample from rural areas, and will implement a remotely-delivered weight gain prevention intervention to medically vulnerable patients. Upcoming trial results will demonstrate the effectiveness of this pragmatic approach to implement and evaluate a digital weight gain prevention intervention within primary care. TRIALS REGISTRATION: NCT03003403 . Registered December 28, 2016.


Assuntos
Aconselhamento/métodos , Obesidade/terapia , Sobrepeso/terapia , Atenção Primária à Saúde/métodos , Programas de Redução de Peso/métodos , Adulto , Centros Comunitários de Saúde , Feminino , Hispano-Americanos , Humanos , Masculino , Tutoria , North Carolina , Obesidade/psicologia , Sobrepeso/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural , Mensagem de Texto , Resultado do Tratamento , Populações Vulneráveis , Ganho de Peso , Perda de Peso
10.
Curr Urol Rep ; 20(7): 36, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31104149

RESUMO

PURPOSE OF REVIEW: The link between metabolic syndrome (MetS)/obesity and kidney stone disease (KSD) has gained importance over recent years due to the increasing prevalence and healthcare burden worldwide. This review analyses the literature exploring the link between MetS/obesity and KSD and the impact that obesity has on KSD management. RECENT FINDINGS: Metabolic syndrome has been shown to increase an individual's risk of developing kidney stone disease, with insulin resistance forming a core component of the pathophysiology. The body habitus of an individual also influences the type of intervention that is most appropriate, with flexible ureteroscopy increasingly being the preferred option in obese patients. It is important for urologists to consider the features of metabolic syndrome to effectively manage episodes of KSD in obese patients. In addition, better quality evidence is required to effectively compare different treatment options in this group of patients.


Assuntos
Cálculos Renais/complicações , Síndrome Metabólica/complicações , Obesidade/complicações , Humanos , Resistência à Insulina , Cálculos Renais/terapia , Litotripsia , Síndrome Metabólica/terapia , Obesidade/terapia , Ureteroscopia
11.
Maturitas ; 125: 45-49, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133216

RESUMO

In recent decades, there has been a marked increase in the prevalence of thyroid cancer. This phenomenon has paralleled the increase in the prevalence of obesity worldwide, which is associated with insulin resistance. Associations between these entities have been hypothesized, mainly for older and female populations, but they remain unclear. The aim of this article is to systematically review the literature in an attempt to determine whether the increase in the prevalence of thyroid cancer is due to obesity or due only to improved detection with the better imaging techniques available. A thorough literature search on PubMed and application of selection criteria identified 15 appropriate studies. The detailed analysis of the data from these studies indicated that there is a suggestive association between thyroid cancer, obesity, insulin resistance and hyperinsulinemia for both genders. Therefore, the increased prevalence of thyroid cancer is not dependent on improved detection only. Further research should be performed for complete understanding of the pathophysiological associations, especially regarding adipose tissue and genetics, but also for the improvement of preventive public health policies.


Assuntos
Resistência à Insulina , Obesidade/sangue , Obesidade/complicações , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/complicações , Tecido Adiposo/patologia , Glicemia/análise , Homeostase , Humanos , Obesidade/terapia , Prevalência , Risco , Neoplasias da Glândula Tireoide/terapia
12.
BMC Health Serv Res ; 19(1): 278, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046766

RESUMO

BACKGROUND: Currently, there is a lack of knowledge, organisation and structure in modern health care systems to counter the global trend of obesity, which has become a major risk factor for noncommunicable diseases. Obesity increases the risk of diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. There is a need to strengthen integrated care between primary and secondary health care and to enhance care delivery suited for patients with complex, long-term problems such as obesity. This study aimed to explore how an educational program for General Practitioners (GPs) can contribute to increased knowledge and improved coordination between primary and secondary care in obesity treatment, and reports on these impacts as perceived by the informants. METHODS: In 2010, an educational program for the specialist training of GPs was launched at three hospitals in Central Norway opting for improved care delivery for patients with obesity. In contrast to the usual programs, this educational program was tailored to the needs of GPs by offering practice and training with a large number of patients with obesity and type 2 diabetes for an extended period of time. In order to investigate the outcomes of the program, a qualitative design was applied involving interviews with 13 GPs, head physicians and staff at the hospitals and in one municipality. RESULTS: Through the program, participants strengthened care delivery by building knowledge and competence. They developed relations between primary and secondary care providers and established shared understanding and practices. The program also demonstrated improvement opportunities, especially concerning the involvement of municipalities. CONCLUSIONS: The educational program promoted integrated care between primary and secondary care by establishing formal and informal relations, by improving service delivery through increased competence and by fostering shared understanding and practices between care levels. The educational program illustrates the combination of advanced high-quality training with the development of integrated care.


Assuntos
Educação Médica Continuada , Clínicos Gerais/educação , Obesidade/terapia , Assistência à Saúde , Diabetes Mellitus Tipo 2/terapia , Humanos , Noruega
13.
Complement Ther Clin Pract ; 35: 316-322, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31003676

RESUMO

BACKGROUND: and purpose: Adolescent obesity has been increasing globally, and intervention is important. This study examined the effects of auricular acupressure on reducing obesity in adolescents. MATERIALS AND METHODS: Participants were 58 obese adolescents, divided into an experimental (n = 32) and a control group (n = 26). The study design was a randomized controlled trial. Auricular acupressure using vaccaria seeds was administered to the experimental group, while placebo auricular acupressure using vaccaria seeds was administered to the control group. Sessions continued for 8 weeks. Outcome measures included body weight, abdominal circumference, hip circumference, waist-hip ratio, body-mass index, body-fat mass, body-fat percentage, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum glucose, and leptin. RESULTS: Adolescents in the experimental group showed significant improvement in total cholesterol levels and low-density lipoprotein cholesterol levels after 8 weeks compared with those in the control group (p < 0.001). CONCLUSION: Auricular acupressure using vaccaria seeds was effective in decreasing total cholesterol levels and low-density lipoprotein cholesterol levels in adolescents with obesity.


Assuntos
Acupuntura Auricular/métodos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Obesidade/terapia , Adolescente , Índice de Massa Corporal , Peso Corporal , Criança , Feminino , Humanos , Masculino , Sementes , Vaccaria , Adulto Jovem
14.
BMC Public Health ; 19(1): 365, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940108

RESUMO

BACKGROUND: Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI). METHODS: In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP. RESULTS: Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (- 4·2 kg vs. - 2·3 kg; difference = - 1·9 kg, 95% CI: -3·7 to - 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI. CONCLUSIONS: The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities. TRIAL REGISTRATION: ISRCTN ISRCTN45820471 . Registered 12/10/2012 (retrospectively registered).


Assuntos
Análise Custo-Benefício , Dieta , Exercício , Obesidade/terapia , Avaliação de Programas e Projetos de Saúde , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Idoso , Peso Corporal , Grupos Étnicos , Feminino , Medicina Geral , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/etnologia , Razão de Chances , Pobreza , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Padrão de Cuidado , Desemprego , Programas de Redução de Peso/economia
15.
Medicine (Baltimore) ; 98(17): e14981, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027051

RESUMO

BACKGROUND/AIMS: Gelidium elegans (GE) is known to have antiobesity effects and beneficial effects on functional bowel symptoms in preclinical studies. The aim of this study was to determine the efficacy and safety of GE intake on bowel symptoms in obese human adults. METHODS: This 12-week single-center randomized double-blind placebo-controlled study was performed from September 2016 to May 2017. Consecutive obese subjects were randomly assigned (1:1) to either GE (1 g) or placebo (1 g) once daily group for 12 weeks. Patients' bowel symptoms were evaluated using the Bristol Stool Form Scale, Constipation Scoring System (CSS), and Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire. RESULTS: The stool symptom score of PAC-SYM significantly improved in the GE group compared with the placebo group after the 12-week treatment (P = .041). Abdominal discomfort score of CSS significantly decreased at 12 weeks compared to that at baseline in the GE group (P = .003), but not in the placebo group (P = .398). In addition, abdominal discomfort score of CSS slightly decreased in the GE group compared with the placebo group after the 12-week treatment (P = .060). However, stool consistency, total CSS score, and PAC-SYM score did not change significantly in both GE group and the placebo group over the 12-week treatment period. CONCLUSIONS: GE treatment for 12 weeks improved the stool symptom score on the PAC-SYM and abdominal discomfort score on the CSS in obese adults. However, further research is needed in large-scale human studies.


Assuntos
Dor Abdominal/terapia , Constipação Intestinal/terapia , Fibras na Dieta/administração & dosagem , Obesidade/terapia , Rodófitas , Adulto , Fibras na Dieta/efeitos adversos , Método Duplo-Cego , Fezes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
16.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 148-154, abr.-jun. 2019. graf
Artigo em Português | LILACS | ID: biblio-1009485

RESUMO

As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil desde o final da década de 1960, a despeito da tendência de queda observada nos últimos anos. A mudança de estilo de vida relacionada à urbanização e globalização, com alta ingestão calórica e menor gasto energético, o rápido aumento da população idosa devido à maior expectativa de vida levaram à maior prevalência de obesidade e dislipidemias e, consequentemente, doenças cardiovasculares e metabólicas. Pesquisas de base populacional, estudos de coorte e de caso e de controle apontam para a importância do crescimento dos fatores de risco e diferenças regionais indicam que as políticas públicas e o atendimento médico devem priorizar intervenções de saúde tendo como objetivo a prevenção e controle dos fatores de risco mais prevalentes em nosso meio. A abordagem terapêutica da obesidade deve incluir não apenas a redução isolada do peso, e sim, atrelada à melhora metabólica ampla que se associe à diminuição do risco de complicações cardiovasculares. De um modo geral, a perda de peso é mais frequentemente alcançada ao longo dos primeiros meses ou do primeiro ano de exposição aos fármacos e embora alguns sejam mais efetivos, eventos adversos são frequentes, limitando o tratamento a longo prazo. O grande avanço e a maior segurança nos últimos anos vieram com o uso de medicamentos antiiperglicemiantes, como análogos de GLP-1, permitindo o uso a longo prazo com manutenção de resultados e adicionando benefícios cardiovasculares. A abordagem terapêutica das dislipidemias no paciente obeso é imperativa para a evolução desse perfil de pacientes, nos quais múltiplos fatores fisiológicos, bioquímicos, metabólicos e clínicos, estão interconectados e diretamente relacionados com aumentos substanciais do risco de diabetes, de doença aterosclerótica cardiovascular e mortalidade por todas as causas


Cardiovascular disease has been the no. 1 cause of death in Brazil since the late 1960s, despite the downtrend observed in recent years. Lifestyle changes related to urbanization and globalization, high calorie intake and lower energy expenditure, combined with a rapidly aging population due to increased life expectancy, have led to a greater prevalence of obesity and dyslipidemia, and consequently, cardiovascular and metabolic diseases. Population-based surveys, cohort and case-control studies underline the importance of the growth of risk factors, and regional differences indicate that public policies and medical care must prioritize health interventions in order to prevent and control the most prevalent risk factors in our country. The therapeutic approach to obesity must include not only weight reduction alone, but also in combination with comprehensive metabolic improvement, which is associated with a reduced risk of cardiovascular complications. In general, weight loss is more frequently achieved in the first few months or first year of exposure to medications, and although some drugs are more effective, adverse events are common, limiting treatment options to long-term therapy. The major advances and greater safety seen in recent years were achieved with the use of anti-hyperglycemic agents such as GLP-1 analogues, enabling long-term use with maintenance of results and adding cardiovascular benefits. The therapeutic approach to dyslipidemia in obese patients is imperative for the progress of this patient population, in which multiple physiological, biochemical, metabolic and clinical factors are interlinked and directly related to substantial increases in the risk of diabetes, atherosclerotic cardiovascular disease, and all-cause mortality


Assuntos
Humanos , Masculino , Feminino , Dieta , Dislipidemias/terapia , Obesidade/prevenção & controle , Obesidade/terapia , Fatores de Tempo , Brasil , Doenças Cardiovasculares/mortalidade , Índice de Massa Corporal , Epidemiologia , Prevalência , Fatores de Risco , Aterosclerose , Sobrepeso/complicações , Estilo de Vida
17.
Nutrients ; 11(4)2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30935031

RESUMO

Osteosarcopenic obesity (OSO) syndrome describes the simultaneous deterioration of bone, muscle and excess fat, resulting in reduced functionality and systemic metabolic dysregulation. The key component contributing to this may be ectopic fat in the viscera, bone and muscle. OSO research to date is summarized, and the revised criteria for its identification for research purposes are reviewed and proposed, including new criteria to assess visceral fat in males and females. Finally, nutritional and physical activity recommendations are consolidated into a treatment algorithm, which can be validated in future studies and which may also be applied to preventative management.


Assuntos
Doenças Ósseas Metabólicas/fisiopatologia , Dietoterapia/métodos , Terapia por Exercício/métodos , Obesidade/fisiopatologia , Osteoporose/fisiopatologia , Sarcopenia/fisiopatologia , Adulto , Idoso , Algoritmos , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/terapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/terapia , Osteoporose/complicações , Osteoporose/terapia , Sarcopenia/complicações , Sarcopenia/terapia
18.
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
19.
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
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