Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.441
Filtrar
1.
N Engl J Med ; 383(8): 721-732, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813948

RESUMO

BACKGROUND: Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss. METHODS: We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. RESULTS: Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 µmol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 µmol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) µmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5±15.9 to 61.6±13.0 µmol per kilogram of fat-free mass per minute in the diet group and from 29.4±12.6 to 54.5±10.4 µmol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group. CONCLUSIONS: In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02207777.).


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Derivação Gástrica , Obesidade/dietoterapia , Obesidade/cirurgia , Perda de Peso/fisiologia , Adulto , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Técnica Clamp de Glucose , Humanos , Insulina/metabolismo , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Indução de Remissão
2.
PLoS Med ; 17(8): e1003136, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760144

RESUMO

BACKGROUND: Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. METHODS AND FINDINGS: This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. CONCLUSIONS: Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.


Assuntos
Estilo de Vida Saudável/fisiologia , Sobrepeso/terapia , Futebol/fisiologia , Perda de Peso/fisiologia , Programas de Redução de Peso/métodos , Adulto , Idoso , Exercício Físico/fisiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade/terapia , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Projetos Piloto , Fatores Sexuais , Método Simples-Cego , Austrália Ocidental/epidemiologia
4.
Nutr. hosp ; 37(3): 474-482, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193854

RESUMO

INTRODUCCIÓN: la obesidad se ha convertido en un problema de salud a nivel mundial de primera magnitud por su relación con la morbimortalidad cardiovascula. Así, la cirugía bariátrica se plantea como una de las soluciones principales para la corrección del exceso de peso y, consecuentemente, la mejoría de las cardiopatías asociadas. OBJETIVO: comparar la gastrectomía vertical (GV) con la derivación biliopancreática de tipo Scopinaro (DBP) para observar la repercusión, desde el punto de vista ecocardiográfico, de los cambios que se producen en la estructura cardiaca tras la cirugía. Además, evaluar el resultado quirúrgico en función de la escala BAROS. MATERIAL Y MÉTODOS: se recogieron los resultados de la ecocardiografía incluida en el estudio preoperatorio de los pacientes candidatos a cirugía bariátrica de nuestro hospital, intervenidos en un periodo de 2 años (de enero 2014 a diciembre 2015), junto a los datos antropométricos y de comorbilidad. Estos se compararon con los resultados postoperatorios medidos a los 3 años de la cirugía. RESULTADOS: finalmente se seleccionaron 26 pacientes (13 GV y 13 DBP), con una edad media de 42 años. GV: IMC inicial de 44,6 ± 17,1; IMC final de 31,8 ± 111,3 (p < 0,01). DBP: IMC inicial de 48,1 ± 14,2; IMC final de 32,7 ± 110,4 (p < 0,01). Ecocardiografía: función sistólica normal: 100% vs. 92%; función diastólica normal: 88,5% vs. 69,2%; sin valvulopatía: 80% vs. 69%; aurícula izquierda normal: 76,9% vs. 73,1% (p > 0,05); HTA: 38% vs. 19% (p < 0,05), en el preoperatorio y postoperatorio, respectivamente. CONCLUSIONES: no se encontraron diferencias significativas entre los dos grupos estudiados con técnicas diferentes, si bien pudo encontrarse un ligero deterioro de la función diastólica en ambos grupos. Las comorbilidades asociadas a la obesidad mejoraron en ambos grupos y el grado de evaluación de la cirugía fue positivo. La escasa variación de la ecocardiografía hace replantearse su uso sistemático en el preoperatorio de estos pacientes por el bajo índice coste-beneficio


INTRODUCTION: obesity has become a worldwide health problem due to its relationship with cardiovascular morbimortality, thus bariatric surgery is considered as one of the main solutions for the correction of excess weight and, consequently, the improvement of its associated heart diseases. OBJECTIVE: to compare vertical gastrectomy (VG) and biliopancreatic diversion (BPD) by observing echocardiographic characteristics both before and after surgery, as well as to evaluate surgical outcome in terms of the BAROS scale. METHODS: results were collected from the echocardiographic testing requested for the preoperative study of patients who underwent surgery over the course of 24 months (from January 2014 to December 2015), as well as their anthropometric data. These were compared with postoperative parameters measured at 3 years after surgery. RESULTS: finally, 26 patients were selected (13 VG and 13 BPD) with a mean age of 42 yrs. VG: initial BMI: 44.6 ± 17.1; final BMI: 31.8 ± 111.3 (p < 0.01); BPD: initial BMI: 48.1 ± 114.2; final BMI: 32.7 ± 110.4 (p < 0.01). Echocardiography: normal systolic function: 100% vs 92%; normal diastolic function: 88.5% vs 69.2%; no valvulopathy: 80% vs 69%; normal left atrium: 76.9% vs 73.1% (p > 0.05); HTA: 38.5% vs 19.2% (p < 0.05), preoperatively and postoperatively, respectively. CONCLUSIONS: no significant differences were found between the two groups studied with different techniques, although a slight deterioration in diastolic function was found in both groups. The comorbidities associated with obesity improved in both groups, and the surgery was scored as positive. The scant variation revealed by echocardiography prompts to reconsider its systematic preoperative use in these patients given the low cost-benefit ratio


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Desvio Biliopancreático/métodos , Gastrectomia/métodos , Ecocardiografia/métodos , Cirurgia Bariátrica/métodos , Período Pré-Operatório , Perda de Peso/fisiologia , Inquéritos e Questionários , Antropometria
5.
Nutr. hosp ; 37(3): 584-588, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193867

RESUMO

INTRODUCTION: to avoid rapid body mass fluctuations and the associated effects on health and performance, some combat sports federations have made changes to regulations. OBJECTIVE: the objective of this study was to analyze the impact of the Rapid Weight Gain on sporting success in elite Olympic wrestling athletes under the new weigh-in procedure. METHODS: the body mass of 75 athletes was recorded during the Pan-American Olympic wrestling Championship (Lima, 2018), corresponding to 29 % of the total universe of competitors (n = 255). Of these, 29 were Greco-Roman style, eight freestyle, and 38 women's wrestling. The official weigh-in was carried out between 8:00 and 8:30 hours. As for the second weigh-in, this was done with the same official weigh-in scale, immediately before the first match (between 10:00 and 11:00 hours). Rapid Weight Gain after weigh-in was compared between medalist and non-medalist athletes. RESULTS: when analyzing the difference between medalists and non-medalists, no significant differences were found in Greco-Roman athletes (t = 0.114; p = 0.910; r = 0.022), in freestyle (Mann-Whitney U = 5,500; p = 0.486; r = 0.000), in women's wrestling (Mann-Whitney U = 163.0; p = 0.774; r = 0.124), and in all competitors (Mann-Whitney U = 641.5; p = 0.855; r = 0.037). CONCLUSIONS: no significant differences were found between medalist and non-medalist athletes in any of the Olympic wrestling styles


INTRODUCCIÓN: para evitar fluctuaciones rápidas del peso corporal y los efectos asociados sobre la salud y rendimiento, algunas federaciones de deportes de combate han realizado cambios de reglamento. OBJETIVO: el objetivo de este estudio fue analizar el impacto de la ganancia rápida de peso en el éxito deportivo en atletas de élite de la lucha olímpica bajo la nueva modalidad de pesaje. MÉTODOS: se registró el peso corporal de 75 atletas durante el Campeonato Panamericano de Lucha Olímpica (Lima, 2018), correspondiente al 29 % del universo total de competidores (n = 255). De estos, 29 fueron de estilo grecorromano; 8, de estilo libre y 38, de lucha libre femenina. El pesaje oficial se realizó entre las 8:00 y las 8:30 horas. En cuanto al segundo pesaje, se hizo con la misma balanza oficial inmediatamente antes de la primera lucha (entre las 10:00 y las 11:00 horas). La ganancia de peso rápida después del pesaje se comparó entre atletas medallistas y no medallistas. RESULTADOS: al analizar la diferencia entre medallistas y no medallistas, no se encontraron diferencias significativas en los atletas de grecorromana (t = 0,114; p = 0,910; r = 0,022), en los de estilo libre (Mann-Whitney U = 5,500; p = 0,486; r = 0,000), en los de lucha libre femenina (Mann-Whitney U = 163,0; p = 0,774; r = 0,124) ni en todos los competidores (Mann -Whitney U = 641,5; p = 0,855; r = 0,037). CONCLUSIONES: no se encontraron diferencias significativas entre atletas medallistas y no medallistas en ninguno de los estilos de lucha olímpica


Assuntos
Humanos , Ganho de Peso/fisiologia , Atletas , Luta Romana/fisiologia , Peso Corporal/fisiologia , Peru , Perda de Peso/fisiologia , Análise de Variância , Índice de Massa Corporal
6.
Womens Health (Lond) ; 16: 1745506520932372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32597335

RESUMO

BACKGROUND: Obesity is an independent risk factor for many diseases. Many studies have investigated the benefits of losing weight as well as the best methods for weight loss. This research evaluated the impact of various weight loss programs on health enhancement among overweight women aged 40-60 years. METHODS: This was a retrospective observational study that analyzed data from 145 overweight women in weight loss programs. Each woman joined one of four programs: 8 weeks of exercise plus diet (exe + nutr), 8 weeks of diet only (nutrition), 8 weeks of exercise only, or a control group. Women completed a psychological questionnaire and also underwent anthropometric tests, blood pressure checks, a predicted maximal oxygen consumption (VO2 max) test on an ergometer bicycle, a one-leg balance test, straight leg test, and a sit and reach test, both before and after the program. Participants also provided a blood sample. RESULTS: All of the measured variables improved in the exe + nutr and nutrition programs when compared with the control group; the exe + nutr group improved the most: body mass index, -1.3 kg/m2; body fat, -2.9%; lean body mass, +1.1; VO2 max, +4.8; body image, +1.02; and p < 0.01. CONCLUSION: The hypothesis-generating findings showed that weight loss programs improved anthropometric, biochemical, physiological, physical, and psychological variables in women aged 40-60 years. The program that included diet restriction with exercise, guidance, and regular counseling showed the best results.


Assuntos
Dieta Redutora , Exercício Físico/fisiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Perda de Peso/fisiologia , Programas de Redução de Peso/normas , Adulto , Índice de Massa Corporal , Feminino , Humanos , Israel , Pessoa de Meia-Idade , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Estudos Retrospectivos
7.
PLoS One ; 15(6): e0233915, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484819

RESUMO

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


Assuntos
Encéfalo/diagnóstico por imagem , Sistema Nervoso Central/fisiopatologia , Cognição/fisiologia , Obesidade/fisiopatologia , Adulto , Anisotropia , Índice de Massa Corporal , Encéfalo/fisiologia , Mapeamento Encefálico , Sistema Nervoso Central/diagnóstico por imagem , Chile/epidemiologia , Imagem de Tensor de Difusão , Movimentos Oculares/fisiologia , Feminino , Humanos , Masculino , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Perda de Peso/fisiologia , Substância Branca/diagnóstico por imagem , Substância Branca/fisiologia , Adulto Jovem
8.
PLoS One ; 15(6): e0235144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579613

RESUMO

BACKGROUND: Commercial physical activity monitors have wide utility in the assessment of physical activity in research and clinical settings, however, the removal of devices results in missing data and has the potential to bias study conclusions. This study aimed to evaluate methods to address missingness in data collected from commercial activity monitors. METHODS: This study utilised 1526 days of near complete data from 109 adults participating in a European weight loss maintenance study (NoHoW). We conducted simulation experiments to test a novel scaling methodology (NoHoW method) and alternative imputation strategies (overall/individual mean imputation, overall/individual multiple imputation, Kalman imputation and random forest imputation). Methods were compared for hourly, daily and 14-day physical activity estimates for steps, total daily energy expenditure (TDEE) and time in physical activity categories. In a second simulation study, individual multiple imputation, Kalman imputation and the NoHoW method were tested at different positions and quantities of missingness. Equivalence testing and root mean squared error (RMSE) were used to evaluate the ability of each of the strategies relative to the true data. RESULTS: The NoHoW method, Kalman imputation and multiple imputation methods remained statistically equivalent (p<0.05) for all physical activity metrics at the 14-day level. In the second simulation study, RMSE tended to increase with increased missingness. Multiple imputation showed the smallest RMSE for Steps and TDEE at lower levels of missingness (<19%) and the Kalman and NoHoW methods were generally superior for imputing time in physical activity categories. CONCLUSION: Individual centred imputation approaches (NoHoW method, Kalman imputation and individual Multiple imputation) offer an effective means to reduce the biases associated with missing data from activity monitors and maximise data retention.


Assuntos
Exercício Físico/fisiologia , Monitores de Aptidão Física/estatística & dados numéricos , Monitorização Fisiológica/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Adulto , Idoso , Algoritmos , Viés , Peso Corporal/fisiologia , Simulação por Computador , Metabolismo Energético/fisiologia , Feminino , Monitores de Aptidão Física/normas , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Projetos de Pesquisa/normas , Perda de Peso/fisiologia , Adulto Jovem
9.
Mutat Res ; 853: 503194, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32522349

RESUMO

Obesity is associated with elevated cancer risk, which may be represented by elevated genomic damage. Oxidative stress plays a key role in obesity related detrimental health consequences including DNA oxidation damage. The elevated cancer risk in obesity may be a consequence. Weight loss has been shown to reduce genomic damage, but the role of oxidative stress in that has not been clarified. The aim of this study is therefore to investigate the influence of bariatric surgery induced weight loss on DNA oxidation damage in morbidly obese subjects. For this aim, we used cryopreserved peripheral blood mononuclear cells in the FPG comet assay. Advanced protein oxidation products and 3-nitrotyrosine were measured as oxidative and nitrative protein stress markers. Furthermore, expression of oxidative stress related proteins HSP70 and Nrf2 as well as mitochondrial enzyme citrate synthase and NADPH oxidase subunit p22 phox were analysed. Our findings revealed significantly reduced DNA strand breaks, but DNA base oxidation was not reduced. We observed significant reduction in plasma AOPPs and 3-nitrotyrosine, which indicated an improvement in oxidative/nitrative stress. However, expression of HSP70 and Nrf2 were not altered after weight loss. In addition, expression of citrate synthase and p22 phox were also unaltered. Overall, bariatric surgery induced significant reduction in excess body weight and improved the patients' health status, including reduced DNA strand breaks and slightly improved antioxidant status in some of the investigated endpoints, while cellular ROS formation and DNA oxidation damage stayed unaltered. This complex situation may be due to combined beneficial effects of weight loss and burdening of the body with fat breakdown products. In the future, collecting samples two years after surgery, when patients have been in a weight plateau for some time, might be a promising approach.


Assuntos
Dano ao DNA/fisiologia , Estresse Oxidativo/fisiologia , Perda de Peso/fisiologia , Adulto , Antioxidantes/metabolismo , Cirurgia Bariátrica/métodos , Ensaio Cometa/métodos , Feminino , Humanos , Leucócitos Mononucleares/metabolismo , Masculino , Obesidade/metabolismo , Obesidade/cirurgia , Oxirredução , Espécies Reativas de Oxigênio/metabolismo
11.
Obesity (Silver Spring) ; 28(6): 1062-1067, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374527

RESUMO

OBJECTIVE: In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss. METHODS: Participants (N = 180; BMI = 33.2 ± 6.0 kg/m2 ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes. RESULTS: Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η2 = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05). CONCLUSIONS: Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.


Assuntos
Obesidade/terapia , Reembolso de Incentivo/normas , Perda de Peso/fisiologia , Programas de Redução de Peso/economia , Adolescente , Adulto , Idoso , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Motivação , Programas de Redução de Peso/métodos , Adulto Jovem
12.
Rev Assoc Med Bras (1992) ; 66(2): 222-226, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428159

RESUMO

OBJECTIVE: To verify the relationship of intermittent fasting in the bodyweight of overweight and obese individuals through a systematic literature review. METHODS: This is a systematic review based on randomized controlled trials. The articles were consulted in the databases: Science Direct, PubMed e BVS. This review was evaluated through the PRISMA recommendation. RESULTS: After the selection process, four articles were included in this review, comparing intermittent fasting (IF) with calorie restriction diet (CRD) as a control group. In 2 studies using similar protocols, there was no significant reduction in body weight of overweight or obese subjects. In the other two studies using different protocols, weight loss was significant in the IF group compared to the CRD group. CONCLUSIONS: Results did not provide evidence of the effect of intermittent fasting on weight loss in overweight or obese individuals.


Assuntos
Peso Corporal/fisiologia , Jejum/fisiologia , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Perda de Peso/fisiologia , Restrição Calórica/métodos , Dieta Redutora/métodos , Humanos , Obesidade/metabolismo , Sobrepeso/metabolismo , Resultado do Tratamento
13.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32350022

RESUMO

A 16-year-old girl presented to her primary care physician with a one-month history of decreased appetite and abdominal pain. She had normal bowel movements and no vomiting, but her periumbilical pain limited her ability to finish most meals. She had gradual weight loss over the previous 2 years, and during the previous 4 years, she intermittently received counseling for depression after the loss of her mother. Her initial physical examination and laboratory evaluation were unremarkable. She was referred to a nutritionist, adolescent medicine, and pediatric gastroenterology. Her presentation evolved over time, which ultimately led to a definitive diagnosis.


Assuntos
Dor Abdominal/diagnóstico , Apetite/fisiologia , Doença de Crohn/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Perda de Peso/fisiologia , Dor Abdominal/etiologia , Dor Abdominal/metabolismo , Adolescente , Doença de Crohn/complicações , Doença de Crohn/metabolismo , Diagnóstico Diferencial , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/metabolismo
14.
PLoS One ; 15(4): e0232152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353079

RESUMO

BACKGROUND: Technological advances in remote monitoring offer new opportunities to quantify body weight patterns in free-living populations. This paper describes body weight fluctuation patterns in response to weekly, holiday (Christmas) and seasonal time periods in a large group of individuals engaged in a weight loss maintenance intervention. METHODS: Data was collected as part The NoHoW Project which was a pan-European weight loss maintenance trial. Three eligible groups were defined for weekly, holiday and seasonal analyses, resulting in inclusion of 1,421, 1,062 and 1,242 participants, respectively. Relative weight patterns were modelled on a time series following removal of trends and grouped by gender, country, BMI and age. RESULTS: Within-week fluctuations of 0.35% were observed, characterised by weekend weight gain and weekday reduction which differed between all groups. Over the Christmas period, weight increased by a mean 1.35% and was not fully compensated for in following months, with some differences between countries observed. Seasonal patterns were primarily characterised by the effect of Christmas weight gain and generally not different between groups. CONCLUSIONS: This evidence may improve current understanding of regular body weight fluctuation patterns and help target future weight management interventions towards periods, and in groups, where weight gain is anticipated.


Assuntos
Férias e Feriados/estatística & dados numéricos , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Programas de Redução de Peso/estatística & dados numéricos , Adulto , Terapia Comportamental/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Estações do Ano
15.
Lancet Diabetes Endocrinol ; 8(6): 477-489, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445735

RESUMO

BACKGROUND: Type 2 diabetes is affecting people at an increasingly younger age, particularly in the Middle East and in north Africa. We aimed to assess whether an intensive lifestyle intervention would lead to significant weight loss and improved glycaemia in young individuals with early diabetes. METHODS: This open-label, parallel-group, randomised controlled trial (DIADEM-I), done in primary care and community settings in Qatar, compared the effects of an intensive lifestyle intervention with usual medical care on weight loss and glycaemic outcomes in individuals with type 2 diabetes, aged 18-50 years, with a short diabetes duration (≤3 years), had a BMI of 27·0 kg/m2 or more, and who were from the Middle East and north Africa region. Participants were randomly allocated (1:1) either to the intensive lifestyle intervention group or the usual medical care control group by a computer-generated sequence and an online randomisation service. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given formula low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support, and a weight-loss maintenance phase, involving structured lifestyle support. Participants in the control group received usual diabetes care, which was based on clinical guidelines. The primary outcome was weight loss at 12 months after receiving the assigned intervention. Our analysis was based on the intention-to-treat principle. Key secondary outcomes included diabetes control and remission. The trial was registered with the ISRCTN registry, ISRCTN20754766, and ClinicalTrials.gov, NCT03225339. FINDINGS: Between July 16, 2017, and Sept 30, 2018, we enrolled and randomly assigned 158 participants (n=79 in each group) to the study. 147 participants (70 in the intervention group and 77 in the control group) were included in the final intention-to-treat analysis population. Between baseline and 12 months, the mean bodyweight of participants in the intervention group reduced by 11·98 kg (95% CI 9·72 to 14·23) compared with 3·98 kg (2·78 to 5·18) in the control group (adjusted mean difference -6·08 kg [95% CI -8·37 to -3·79], p<0·0001). In the intervention group, 21% of participants achieved more than 15% weight loss between baseline and 12 months compared with 1% of participants in the control group (p<0·0001). Diabetes remission occurred in 61% of participants in the intervention group compared with 12% of those in the control group (odds ratio [OR] 12·03 [95% CI 5·17 to 28·03], p<0·0001). 33% of participants in the intervention group had normoglycaemia compared with 4% of participants in the control group (OR 12·07 [3·43 to 42·45], p<0·0001). Five serious adverse events were reported in four participants in the control group; four admissions to hospital because of unanticipated events (supraventricular tachycardia, abdominal pain, pneumonia, and epididymo-orchitis), and one admission to hospital for an anticipanted event (hyperglycaemia). INTERPRETATION: Our findings show that the intensive lifestyle intervention led to significant weight loss at 12 months, and was associated with diabetes remission in over 60% of participants and normoglycaemia in over 30% of participants. The provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and wellbeing. FUNDING: Qatar National Research Fund.


Assuntos
Glicemia/metabolismo , Peso Corporal/fisiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Índice Glicêmico/fisiologia , Comportamento de Redução do Risco , Adolescente , Adulto , África do Norte/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Resultado do Tratamento , Perda de Peso/fisiologia , Adulto Jovem
16.
Lancet Diabetes Endocrinol ; 8(6): 490-500, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445736

RESUMO

BACKGROUND: Excess gestational weight gain (GWG) among women with overweight or obesity synergistically increases their already elevated risk of having gestational diabetes, a caesarean delivery, a large for gestational age infant, and post-partum weight retention, and increases their child's risk of obesity. We investigated whether a primarily telehealth lifestyle intervention reduced excess GWG among women with overweight or obesity. METHODS: We did a randomised controlled trial in five antenatal clinics of Kaiser Permanente; Oakland, San Leandro, Walnut Creek, Fremont, and Santa Clara, CA, USA. Women at 8-15 weeks' gestation with singletons, pre-pregnancy BMI 25·0-40·0 kg/m2, and aged 18 years or older were randomly assigned (1:1) to receive the telehealth lifestyle intervention or usual antenatal care. Randomisation was adaptively balanced for age, BMI, and race and ethnicity. Data collectors and investigators were masked to group assignments. The core lifestyle intervention consisted of two in-person and 11 telephone sessions on behavioural strategies to improve weight, diet, and physical activity, and stress management to help women meet a trial goal of gaining at the lower limit of the Institute of Medicine (IOM) guidelines range for total GWG: 7 kg for women with overweight and 5 kg for women with obesity. Usual antenatal care included an antenatal visit at 7-10 weeks' gestation, an additional seven antenatal visits, on average, and periodic health education newsletters, including the IOM GWG guidelines and information on healthy eating and physical activity in pregnancy. The primary outcome was weekly rate of GWG expressed as excess GWG, per Institute of Medicine guidelines and mean assessed in the intention-to-treat population. The trial is registered at ClinicalTrials.gov, NCT02130232. FINDINGS: Between March 24, 2014, and Sept 26, 2017, 5329 women were assessed for eligibility and 200 were randomly assigned to the lifestyle intervention group and 198 to the usual care group. Analyses included 199 women in the lifestyle intervention group (one lost to follow-up) and 195 in the usual care group (three lost to follow-up). 96 (48%) women in the lifestyle intervention group and 134 (69%) women in the usual care group exceeded Institute of Medicine guidelines for rate of GWG per week (relative risk 0·70, 95% CI 0·59 to 0·83). Compared with usual care, women in the lifestyle intervention had reduced weekly rate of GWG (mean 0·26 kg per week [SD 0·15] vs 0·32 kg per week [0·13]; mean between-group difference -0·07 kg per week, 95% CI -0·09 to -0·04). No between-group differences in perinatal complications were observed. INTERPRETATION: Our evidence-based programme showed that health-care delivery systems could further adapt to meet the needs of their clinical settings to prevent excess GWG and improve healthy behaviours and markers of insulin resistance among women with overweight or obesity by using telehealth lifestyle interventions. FUNDING: US National Institutes of Health.


Assuntos
Ganho de Peso na Gestação/fisiologia , Sobrepeso/terapia , Cuidado Pré-Natal/métodos , Comportamento de Redução do Risco , Telemedicina/métodos , Adulto , Exercício Físico/fisiologia , Feminino , Seguimentos , Humanos , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/terapia , Sobrepeso/sangue , Sobrepeso/diagnóstico , Gravidez , Perda de Peso/fisiologia , Adulto Jovem
17.
Am J Clin Nutr ; 112(3): 558-565, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386226

RESUMO

BACKGROUND: The existence of metabolic adaptation, at the level of resting metabolic rate (RMR), remains highly controversial, likely due to lack of standardization of participants' energy balance. Moreover, its role as a driver of relapse remains unproven. OBJECTIVE: The main aim was to determine if metabolic adaptation at the level of RMR was present after weight loss and at 1- and 2-y follow-up, with measurements taken under condition of weight stability. A secondary aim was to investigate race differences in metabolic adaptation after weight loss and if this phenomenon was associated with weight regain. METHODS: A total of 171 overweight women [BMI (kg/m2): 28.3 ± 1.3; age: 35.2 ± 6.3 y; 88 whites and 83 blacks] enrolled in a weight-loss program to achieve a BMI <25, and were followed for 2 y. Body weight and composition (4-compartment model) and RMR (indirect calorimetry) were measured after 4 wk of weight stability at baseline, after weight loss and at 1 and 2 y. Metabolic adaptation was defined as a significantly lower measured compared with predicted RMR (from own regression model). RESULTS: Participants lost, on average, 12 ± 2.6 kg and regained 52% ± 38% and 89% ± 54% of their initial weight lost at 1 and 2 y follow-up, respectively. Metabolic adaptation was found after weight loss (-54 ± 105 kcal/d; P < 0.001), with no difference between races and was positively correlated with fat-mass loss, but not with weight regain, overall. In a subset of women (n = 46) with data at all time points, metabolic adaptation was present after weight loss, but not at 1- or 2-y follow-up (-43 ± 119, P = 0.019; -18 ± 134, P = 0.380; and - 19 ± 166, P = 0.438 kcal/day respectively). CONCLUSIONS: In overweight women, metabolic adaptation at the level of RMR is minimal when measurements are taken under conditions of weight stability and does not predict weight regain up to 2 years follow-up.The JULIET study is registered at https://clinicaltrials.gov/ct2/show/NCT00067873 as NCT00067873.


Assuntos
Adaptação Fisiológica , Manutenção do Peso Corporal/fisiologia , Perda de Peso/fisiologia , Adulto , Metabolismo Basal , Dieta Redutora , Feminino , Humanos , Obesidade/metabolismo , Adulto Jovem
18.
Medicine (Baltimore) ; 99(19): e19823, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384427

RESUMO

BACKGROUND/AIM: Obesity is associated with increased incidence of gastroesophageal reflux disease (GERD), and it has been suggested that GERD symptoms may be improved by weight reduction. However, various patterns of bariatric surgery may affect symptoms of GERD due to the changed anatomy of stomach and esophagus. The aim of this systematic review and meta-analysis is to analyze the effect of bariatric surgery on GERD. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, EMBASE, and the Cochrane Library from January 2005 to January 2019, combining the words obesity, gastroesophageal reflux with different types of bariatric surgery and weight loss. The methodological quality of randomized controlled trials and non-randomized controlled trials published in English and have at least 1-year follow-up data were included and assessed by Cochrane Collaboration's tool for assessing risk bias and Newcastle-Ottawa scale. Only clinical trials were included, and case series or case reports were excluded. RESULTS: We anticipate that our review will provide the exact estimates of the burden and phenotype of GERD among patients that have undergone bariatric surgery. CONCLUSION: GERD may improve in obese patients who underwent laparoscopic sleeve gastrectomy (LSG); however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. PROSPERO REGISTRATION NUMBER: CRD42018090074.


Assuntos
Cirurgia Bariátrica , Refluxo Gastroesofágico/cirurgia , Obesidade Mórbida/cirurgia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/fisiopatologia , Humanos , Metanálise como Assunto , Obesidade Mórbida/complicações , Obesidade Mórbida/fisiopatologia , Período Pós-Operatório , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Perda de Peso/fisiologia
19.
Obesity (Silver Spring) ; 28(6): 1075-1085, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32348021

RESUMO

OBJECTIVE: Identifying novel approaches to combat obesity is important to improve health span. It was hypothesized that methionine restriction (MR) will induce weight loss in obese mice by reducing adipose tissue mass caused by increased energy expenditure and reprogramming of adipose tissue homeostasis. The roles of adiponectin (ADIPOQ) and fibroblast growth factor 21 (FGF21) during weight loss in MR mice were also tested. METHODS: Diet-induced obese (DIO) male C57BL/6J (wild type), Adipoq-deficient (Adipoq knockout [KO]), Fgf21-KO, and Adipoq-Fgf21 double-KO mice were used. Following a switch to high-fat control (DIO-CF, 60% fat/0.86% methionine) or MR (DIO-MR, 60% fat/0.12% methionine) diet, physiological parameters were measured, and inguinal and perigonadal adipose tissues were examined. RESULTS: Obese mice subjected to MR showed loss of body weight and adiposity, increased energy expenditure, and improved glucose tolerance that were independent of the actions of ADIPOQ and FGF21. MR induced reduction of circulating lipids, glucose, insulin, leptin, and insulin like growth factor 1 and increased ß-hydroxybutyrate, ADIPOQ, and FGF21 concentrations. In fat, MR upregulated protein levels of adipose triglyceride lipase, apoptosis-inducing factor, lysosomal-associated membrane proteins 1 and 2, autophagy-related protein 5, beclin-1, and light chain 3B I and II. CONCLUSIONS: MR reduction of adipose tissue mass in obese mice is associated with elevated lipolysis, apoptosis, and autophagy and occurs independently of the actions of ADIPOQ and FGF21.


Assuntos
Adiponectina/metabolismo , Adiposidade/fisiologia , Fatores de Crescimento de Fibroblastos/metabolismo , Metionina/metabolismo , Camundongos Obesos/genética , Perda de Peso/fisiologia , Animais , Masculino , Camundongos
20.
Stroke ; 51(5): 1435-1441, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32268850

RESUMO

Background and Purpose- The importance of weight change for the risk of stroke is not well known. We examined the associations between early- and mid-life weight change and risks of stroke and death during long-term follow-up of healthy men. Methods- We recruited healthy men aged between 40 and 59 years and performed a cardiovascular examination at baseline and again at 7 years. We collected data on weight change since the age of 25 (early-life weight change) and measured weight change from baseline to the visit at 7 years (mid-life weight change). For both weight change periods, participants were divided into the following categories: weight loss, weight gain 0 to 4.9 kg, weight gain 5 to 9.9 kg, and weight gain ≥10 kg. Data on stroke and death were collected up to 35 years, from study visits, hospital records, and the National Cause of Death Registry. We used Cox regression to analyze the associations between weight change during early-life and mid-life and risks of stroke and death. Results- Of the 2014 participants, 2014 (100%) had data on early-life weight change and were followed for a median of 30.1 years, while 1403 had data on mid-life weight change and were followed for a median of 24.6 years. During early-life, compared with those who had weight gain 0 to 4.9 kg, hazard ratio for stroke was 1.46 (95% CI, 1.09-1.95) among those with weight gain 5 to 9.9 kg, 1.39 (95% CI, 1.03-1.87) for those with weight gain ≥10 kg, and 1.46 (95% CI, 0.99-2.11) among those with weight loss. For all-cause death, the hazard ratios were 1.08 (95% CI, 0.92-1.23), 1.14 (95% CI, 0.98-1.33), and 1.29 (95% CI, 1.06-1.56), respectively. During mid-life, there were no significant differences in risk of stroke or death between the groups. Conclusions- Weight increase during early-life, but not mid-life, seems to be associated with increased long-term risk of stroke in healthy men. If these findings can be confirmed, efforts to prevent weight increase should target the younger population.


Assuntos
Peso Corporal/fisiologia , Acidente Vascular Cerebral/epidemiologia , Tempo , Ganho de Peso/fisiologia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sistema de Registros , Fatores de Risco , Perda de Peso/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA