Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis

Abstract Objective Although obesity can result in high morbidity and mortality in surgical outcomes because of multiple comorbidities, determinants of outcome in obese patients who underwent endometrial cancer surgery remain unclear. The aim of this study is to assess the relationship between body mass index (BMI) and surgical outcomes in obese patients with endometrial cancer. Methods An institutional retrospective review of the demographic details, clinical characteristics, and follow-up data of 142 patients with endometrial cancer who underwent surgery during a 72-month period was performed. The patients were divided into three groups based on their BMI; patients with BMI < 25 were identified as normal weight, patients with BMI between 25 and 30 were accepted as overweight, and those with BMI ≥ 30 kg/m2 were identified as obese. The groups' demographic and clinical variables were compared. Results Of the 142 patients, 42 were in the normal weight group, 55 in the overweight group, and 45 in the obese group. Age, surgical procedures, blood loss, preoperative health status, and metastatic lymph nodes did not show a significant difference between groups. However, surgery time and total lymph nodes were higher in the obese group. (p = 0.02, p = 0.00, and p = 0.00, respectively). Common complications were anemia, fever, intestinal injury, deep vein thrombosis, fascial dehiscence and urinary infection. There was no significant difference according to the complications. Conclusion Our results indicated that higher BMI was significantly associated with a longer duration of endometrial cancer surgery. Minimally invasive surgeries and conventional laparotomy could be performed safely in obese patients.

Cirugía laparoscópica en pacientes con obesidad mórbida y cáncer de endometrio

Introducción: La cirugía, en pacientes con obesidad mórbida, como tratamiento del cáncer ginecológico supone un reto para el cirujano y el anestesiólogo, pues se asocia a un incremento de las complicaciones intra y posoperatorias. Objetivo: Describir los principales resultados con la cirugía laparoscópica, en pacientes con obesidad mórbida y adenocarcinoma de endometrio, tratadas en el Instituto Nacional de Oncología y Radiobiología (INOR) de la Habana, Cuba, en el período comprendido enero de 2019 a marzo de 2020. Método: Se realizó un estudio descriptivo, observacional y transversal, en 22 pacientes con índice de masa corporal mayor de 40 kg/m2 y diagnóstico de adenocarcinoma de endometrio, que fueron sometidas a cirugía laparoscópica. El dato primario fue obtenido a través de las historias clínicas, con los que se confeccionó una base de datos en una hoja de Microsoft Excel para sintetizar toda la información. Resultados: Predominó la edad entre 61 a 70 años. El adenocarcinoma endometrioide fue el más frecuente con el 77,27 %. El grado de diferenciación fue el bien diferenciado, infiltrando menos del 50 % del miometrio. El estadiamiento quirúrgico predominante fue el IA (72,72 %). El sangrado transoperatorio fue de 78,9 ± 5,7ml (rango 10 y 200 ml), la media del acto operatorio de 82 min (rango 75-132 min), y la estadía hospitalaria de menos de 24 horas (90,90 %). La conversión quirúrgica se realizó en el 4,54 % de los casos. Conclusiones: Las pacientes con obesidad mórbida pueden beneficiarse del abordaje laparoscópico para el tratamiento y la estatificación quirúrgica laparoscópica del carcinoma endometrial, lo que disminuye la morbilidad y la estadía hospitalaria.

Introduction: Surgery in morbidly obese patients as a treatment for gynecologic cancer is a challenge for surgeons and anesthesiologists, since it is associated with the processes of increasing intraoperative and postoperative complications. Objective: To describe the main results gained with the use of laparoscopic surgery in patients with morbid obesity and endometrial adenocarcinoma treated at the Instituto Nacional de Oncología y Radiobiología (INOR) of Havana, Cuba, from January 2019 to March 2020. Method: A descriptive, observational, cross-sectional study was carried out in 22 patients, with body mass index more than 40 kg/m2 and diagnosis of endometrial adenocarcinoma, who underwent laparoscopic surgery. The primary data was obtained from the medical records, which were used to create a database in a Microsoft Excel spreadsheet to synthesize all the information. Results: The predominant age group was between 61 and 70 years old. Endometrial adenocarcinoma was the most frequent cancer (77.27%). The degree of differentiation was well differentiated, infiltrating less than 50 % of the myometrium. The predominant surgical staging was IA (72.72%). Transoperative bleeding was 78.9 ± 5.7 ml (range between 10 and 200 ml), mean operative time was 82 min (range 75-132 min), and hospital stay was less than 24 hours (90.90%). Surgical conversion was performed in 4.54% of cases. Conclusions: Morbidly obese patients may benefit from the laparoscopic approach for the treatment and laparoscopic surgical staging of endometrial carcinoma, which decreases morbidity and hospital stay.

Introdução: A cirurgia, em pacientes com obesidade mórbida, como tratamento para o câncer ginecológico é um desafio para o cirurgião e para o anestesiologista, pois está associada ao aumento de complicações intra e pós-operatórias. Objetivo: Descrever os principais resultados da cirurgia laparoscópica, em pacientes com obesidade mórbida e adenocarcinoma endometrial, tratados no Instituto Nacional de Oncología y Radiobiología (INOR) em Havana, Cuba, no período de janeiro de 2019 a março de 2020. Método: A estudo descritivo, observacional e transversal realizado em 22 pacientes com índice de massa corporal superior a 40 kg/m2 e diagnóstico de adenocarcinoma de endométrio, submetidas à cirurgia laparoscópica. Os dados primários foram obtidos por meio dos prontuários, com os quais foi criado um banco de dados em uma planilha do Microsoft Excel para sintetizar todas as informações. Resultados: Predominou a idade entre 61 a 70 anos. O adenocarcinoma endometrioide foi o mais frequente com 77,27%. O grau de diferenciação foi bem diferenciado, infiltrando menos de 50% do miométrio. O estadiamento cirúrgico predominante foi IA (72,72%). O sangramento transoperatório foi de 78,9 ± 5,7 ml (variação de 10 e 200 ml), a média do ato cirúrgico foi de 82 min (variação de 75-132 min) e o tempo de internação foi inferior a 24 horas (90,90%). A conversão cirúrgica foi realizada em 4,54% dos casos. Conclusões: Pacientes com obesidade mórbida podem se beneficiar da abordagem laparoscópica para o tratamento e estadiamento cirúrgico laparoscópico do carcinoma endometrial, o que diminui a morbidade e o tempo de internação.

Obesidade com depleção muscular em indivíduos rastreados para o câncer colorretal / Muscle depleted obesity in individuals screened for colorectal câncer

ABSTRACT Background: Colorectal cancer (CRC) is the third most incident cancer in the world and the second leading cause of cancer death. Significant decreases in incidence and mortality can be achieved by reducing risk factors and adhering to healthy lifestyle recommendations, as well as screening for the disease. Objective: To evaluate the clinical nutritional profile of individuals at medium risk screened for CRC residing in the city of Piranhas/Alagoas. Methods: Cross-sectional study conducted from September to October 2020, with individuals at medium risk for CRC, of both sexes and aged between 50 and 70 years old. Participants were screened for CRC with fecal immunochemical testing (FIT) and colonoscopy. Personal, socioeconomic, clinical, lifestyle and nutritional assessment data were collected. The latter was performed using anthropometric data (weight, height, arm circumference and triceps skinfold thickness), body composition (bioimpedance) and physical examination. Descriptive analysis of data frequencies and dichotomization according to the presence or absence of overweight was performed, followed by comparison of means and medians and frequencies by chi-square or Fisher's exact test. Results: In total, 82 people agreed to undergo the clinical nutritional assessment, most of them female (56.1%; n=46), adults (56.1%; n=46), with a mean age of 59.02 years (±6.30 SD). Pre-cancerous lesions were identified in 54.5% (n=42) of those screened, 52.4% (n=43) were smokers or former smokers, and 65.9% (n=54) did not practice scheduled physical activity. Nutritional assessment showed that 64.6% (n=53) were overweight according to body mass index. On the other hand, the muscle mass, % arm muscle circumference adequacy and body muscle mass (kg) markers showed that 32.9% (n=27) and 47.6% (n=39) of the subjects were muscle depleted, respectively. Above all, overweight participants had, in parallel, lower muscle mass (P<0.05), suggesting sarcopenic obesity in this population. Conclusion: Obesity is one of the main risk factors for CRC; when concomitant with sarcopenia, it favors worse health outcomes. In this context, evidence shows the need to assess muscle composition in people with obesity, especially through other methods of assessing body composition. Our results add to the evidence on the importance of the population being guided about screening and adherence to healthy lifestyle recommendations, especially strategies aimed at weight control and the practice of physical activity.

RESUMO Contexto: O câncer colorretal (CCR) é o terceiro câncer mais incidente no mundo e a segunda principal causa de morte por câncer. Diminuições significativas da incidência e mortalidade podem ser alcançadas a partir da redução de fatores de risco e adesão às recomendações de estilo de vida saudável, bem como rastreamento da doença. Objetivo: Avaliar o perfil clínico nutricional de indivíduos em risco médio rastreados para o CCR residentes na cidade de Piranhas/Alagoas. Métodos: Estudo transversal, conduzido de setembro a outubro de 2020, com indivíduos de médio risco para o CCR, de ambos os sexos e idades entre 50 e 70 anos. Os participantes realizaram rastreamento para o CCR com teste imunoquímico fecal (FIT) e colonoscopia. Foram coletados dados pessoais, socioeconômicos, clínicos, de estilo de vida e avaliação nutricional. Esta última foi realizada através de dados antropométricos (peso, altura, circunferência do braço e prega cutânea tricipital), composição corporal (bioimpedância) e exame físico. Foi realizada análise descritiva das frequências dos dados e dicotomização segundo a presença ou não de excesso de peso, seguida da comparação de médias e medianas e das frequências por qui-quadrado ou teste exato de Fisher. Resultados: No total, 82 pessoas aceitaram realizar a avaliação clínica nutricional, a maioria do sexo feminino (56,1%; n=46), adultos (56,1%; n=46), com média de idade de 59,02 anos (±6,30 DP). Foram identificadas lesões pré-cancerígenas em 54,5% (n=42) dos rastreados, 52,4% (n=43) eram tabagista ou ex-tabagista e 65,9% (n=54) não praticavam atividade física programada. A avaliação nutricional demonstrou que 64,6% (n=53) estavam com excesso de peso pelo índice de massa corporal (IMC). Em contrapartida, os marcadores de massa muscular, % de adequação da circunferência muscular do braço (CMB) e massa muscular corporal (kg), mostraram que 32,9% (n=27) e 47,6% (n=39) dos indivíduos estavam com depleção muscular, respectivamente. Sobretudo os participantes com excesso de peso apresentavam, paralelamente, menor massa muscular (P<0,05), sugerindo obesidade sarcopênica nessa população. Conclusão: A obesidade é um dos principais fatores de risco para o CCR; quando concomitante a sarcopenia, favorece a piores desfechos para saúde. Nesse contexto, as evidências mostram a necessidade de avaliar a composição muscular em pessoas com obesidade, sobretudo, por outros métodos de avaliação da composição corporal. Nossos resultados se somam as evidências sobre a importância da população ser orientada sobre o rastreamento e adesão às recomendações de estilo de vida saudável, principalmente estratégias voltadas para o controle de peso e a prática de atividade física.

The Microbiota-Gut-Brain Axis: Clinical Applications in Obesity and Type 2 Diabetes

ABSTRACT Recent investigations highlight the importance of the gut microbiota and bacteria-derived metabolites as key components in obesity and metabolic health. The microbiota-gut-brain axis presents promising targets for future obesity treatments and prevention. However, the current state of evidence and existing clinical applications of the microbiota-gut-brain axis have yet to be summarized in a thorough review. Therefore, we sought to examine current evidence on the effect of lifestyle, dietary, pharmacological, and surgical interventions on the microbiota-gut-brain axis. In addition, this review highlights potential next steps in research toward characterizing the role of the microbiota-gut-brain axis in metabolic health, along with possible interventions to address obesity.

Baipás gástrico versus manga gástrica para el controlde diabetes tipo 2 en pacientes obesos / Gastric bypass versus gastric sleeve for the management of type 2 diabetes in obese patients

Introducción. La diabetes mellitus tipo 2 y la obesidad son enfermedades con alta prevalencia, gran morbi-mortalidad y elevados costos en salud. La cirugía bariátrica ha demostrado efectividad para inducir pérdida de peso y un control adecuado de la glicemia. Métodos. Estudio observacional analítico retrospectivo, realizado entre 2014 y 2019 en una institución de alta complejidad. Se incluyeron pacientes prediabéticos y diabéticos sometidos a cirugía bariátrica tipo baipás gástrico en Y-de-Roux o manga gástrica. Se analizaron la mejoría o resolución de la diabetes y la pérdida del exceso de peso a los 6, 12, 24 y 36 meses luego de la cirugía. Resultados. Se incluyeron 103 pacientes en el estudio, 45 pacientes diabéticos y 58 pacientes prediabéticos. La única variable perioperatoria con diferencia estadísticamente significativa fue el tiempo quirúrgico mayor en el baipás (70 vs. 47,5 minutos; p<0,001). La pérdida de exceso de peso fue mayor en el baipás. Los pacientes diabéticos sometidos a baipás tuvieron un mayor porcentaje de resolución o control comparados con los sometidos a manga gástrica. En los pacientes prediabéticos hubo resolución en ambos grupos luego de 24 meses de seguimiento. Conclusión. El baipás gástrico y la manga gástrica presentan excelentes resultados en cuanto a pérdida de peso y control metabólico en pacientes con diabetes mellitus tipo 2 y prediabetes, pero en nuestros pacientes se lograron resultados superiores en ambos aspectos con el baipás gástrico

Introduction. Type 2 diabetes mellitus and obesity are diseases with high prevalence, high morbidity and mortality and high health costs. Bariatric surgery has proven effective in inducing weight loss and adequate glycemic control. Methods. Retrospective analytical observational study conducted between 2014 and 2019 in a high-complex institution. Prediabetic and diabetic patients undergoing Roux-en-Y gastric bypass or gastric sleeve were included; analyzing the improvement or resolution of diabetes and the loss of excess weight at 6, 12, 24 and 36 months after surgery. Results. One-hundred and three patients were included in the study, 45 diabetic patients and 58 pre-diabetic patients. The only perioperative variable with a statistically significant difference was the longer surgical time in the bypass (70 vs. 47.5 min; p<0.001). Loss of excess weight was always greater in bypass. Diabetic patients who underwent bypass had a higher percentage of resolution or control compared to those who underwent the sleeve procedure. In pre-diabetic patients, there was 100% resolution in both groups after 24 months of follow-up. Conclusion. Gastric bypass and gastric sleeve present excellent results in terms of weight loss and metabolic control in patients with type 2 diabetes mellitus and pre-diabetes, but superior results in both aspects were achieved with the first technique in our patients

Fatores de riscos cardiovasculares de estudantes do curso de enfermagem de uma universidade particular / Cardiovascular ricks factors of nursing students at a private university / Factores de riesgo cardiovascular de los estudiantes de enfermería de una universidad privada

Introdução: Os riscos de desenvolvimento de doenças cardiovasculares são altamente prevalentes em indivíduos idosos, contudo essa condição tem crescido de maneira preocupante em adultos jovens, principalmente em acadêmicos de graduação. Essa condição pode estar relacionada a vários comportamentos de risco, associados às doenças cardiovasculares, como má alimentação, baixos níveis de atividade física, sobrepeso, etc. Objetivo: Identificar a prevalência dos riscos cardiovasculares em acadêmicos do Curso de Enfermagem de uma universidade particular do Sudoeste do Paraná. Metodologia: Pesquisa transversal, realizada em acadêmicos do Curso de Enfermagem de uma universidade particular do Sudoeste do Paraná. Avaliaram-se 99 acadêmicos do Curso de Enfermagem, que assinaram o Termo de Consentimento Livre e Esclarecido. Utilizou-se para coleta de dados um formulário eletrônico, disponibilizado nos endereços eletrônicos, WhatsApp e Classroom dos acadêmicos. O instrumento continha questões sobre autorrelato de medidas antropométricas (peso, estatura, circunferência de cintura) e pressão arterial, além de questões objetivas sobre consumo de álcool, medicamentos, doença existente, nível de atividade física habitual e bem-estar geral. Para análise dos dados, empregou-se estatística descritiva e Teste U de Mann- Withney, com nível de significância de p<0,05. Resultados: Observou-se que nos fatores de riscos cardiovasculares de Índice de Massa Corporal, Pressão Arterial e Circunferência Abdominal, os acadêmicos apresentaram valores médios adequados de acordo com tabelas normativas, cujos dados dos homens foram significativamente maiores em todas as variáveis analisadas (p<0,05). Para hábito de fumar e consumo de álcool diário, observou-se percentual baixo (3% e 2%, respectivamente). Verificou-se que 28,3% dos estudantes relataram ter alguma doença preexistente e 58,6% informaram fazer uso contínuo de alguma medicação. Observou-se, ainda, os percentuais de inadequação para pressão arterial (6,5%), Circunferência Abdominal (27%), Índice de Massa Corporal (28,3%) e Nível de Atividades Físicas Habitual (46,6%). A agregação de dois e quatro ou mais fatores de risco foi mais prevalente em mulheres, ao passo que os homens apresentaram maior agregação e três fatores. Conclusão: Os universitários do Curso de Enfermagem analisado apresentaram percentuais importantes de fatores de riscos cardiovasculares, principalmente em relação ao estado de sobrepeso ou obesidade e sedentarismo.

Introduction: The risks of developing cardiovascular diseases are highly prevalent in elderly individuals, however, this condition has grown alarmingly in young adults, especially in undergraduate students. This condition may be due to various risk behaviors associated with cardiovascular diseases, such as poor diet, low levels of physical activity, overweight, etc. Objective: To identify the prevalence of cardiovascular risks in undergraduate Nursing students at a private university in the southwest of Paraná. Methodology: It was a cross-sectional research, carried out in Nursing students from a private university in the Southwest of Paraná. 99 students of the Nursing Course were evaluated, who signed the Informed Consent Term. An electronic form was used for data collection, available at the academic addresses, WhatsApp and Classroom. The instrument contained self-reported anthropometric measurements (weight, height, waist circumference) and blood pressure, and objective questions about alcohol consumption, medication, existing disease, habitual physical activity level and well be general. For data analysis, was used descriptive statistics and Mann-Withney U test with a significance level of p <0.05. Results: It was observed that in the cardiovascular risk factors of body mass index, blood pressure and waist circumference, the students presented adequate average values according to normative tables, and the data of men were significantly higher in all variables analyzed (p <0.05). For smoking habits and daily alcohol consumption, a low percentage was observed (3% and 2% respectively). It was found that 28.3% of the students reported having a pre-existing disease and 58.6% reported making continuous use of some medication. It also observed the percentage of inadequacy for blood pressure (6.5%), waist circumference (27%), Body Mass Index (28.3%) and habitual physical activity level (46.6%). The aggregation of two and, four or more risk factors was more prevalent in women, whereas men showed greater aggregation and three factors. Conclusion: The university students of the analyzed nursing course presented important percentages of cardiovascular risk factors, mainly in relation to the state of overweight or obesity and physical inactivity.

Introducción: Los riesgos de desarrollar enfermedades cardiovasculares son altamente prevalentes en individuos de edad avanzada, sin embargo esta condición ha ido aumentando de manera preocupante en adultos jóvenes, especialmente en estudiantes de pregrado. Esta afección puede estar relacionada con varios comportamientos de riesgo asociados a las enfermedades cardiovasculares, como la mala alimentación, los bajos niveles de actividad física, el sobrepeso, etc. Objetivo: Identificar la prevalencia de riesgos cardiovasculares en estudiantes de pregrado de enfermería de una universidad privada del suroeste de Paraná. Metodología: Investigación transversal, realizada en académicos del Curso de Enfermería de una universidad particular del Sudoeste de Paraná. El estudio evaluó a 99 estudiantes de enfermería que firmaron el formulario de consentimiento libre e informado. Para la recogida de datos, se utilizó un formulario electrónico que se puso a disposición de los alumnos en sus direcciones electrónicas, WhatsApp y Aula. El instrumento contenía preguntas sobre las medidas antropométricas (peso, altura, perímetro de la cintura) y la presión arterial declaradas por el propio paciente, así como preguntas objetivas sobre el consumo de alcohol, la medicación, las enfermedades existentes, el nivel de actividad física habitual y el bienestar general. Para el análisis de los datos se emplearon estadísticas descriptivas y la prueba U de Mann-Withney, con un nivel de significación de p<0,05. Resultados: Se observó que en los factores de riesgo cardiovascular de Índice de Masa Corporal, Presión Arterial y Circunferencia Abdominal, los académicos mostraron valores medios adecuados según tablas normativas, cuyos datos de los hombres fueron significativamente mayores en todas las variables analizadas (p<0,05). En cuanto al hábito de fumar y al consumo diario de alcohol, se observó un bajo porcentaje (3% y 2%, respectivamente). Se comprobó que el 28,3% de los estudiantes declaró tener alguna enfermedad preexistente y el 58,6% informó del uso continuo de algún medicamento. También se observaron los porcentajes de inadecuación para la presión arterial (6,5%), el perímetro abdominal (27%), el índice de masa corporal (28,3%) y el nivel de actividad física habitual (46,6%). La agregación de dos y cuatro o más factores de riesgo fue más frecuente en las mujeres, mientras que los hombres mostraron una mayor agregación y tres factores. Conclusión: Los estudiantes de pregrado del Curso de Enfermería analizados presentaron porcentajes importantes de factores de riesgo cardiovascular, especialmente en relación con el estado de sobrepeso u obesidad y el sedentarismo.

Analysis of the Influence of Abdominal Obesity on Systemic Arterial Hypertension and on the Lipid Profile on Cardiometabolic Risk Stratification in Adult Women

Abstract Background: Obesity is a public health problem and has been associated with the development of metabolic disorders that have a strong relationship with the onset of cardiovascular diseases (CVD). Objective: The objective was to analyze the influence of abdominal obesity (AO) on systemic arterial hypertension (SAH) and on the lipid profile in cardiovascular risk stratification in adult women. Methods: Altogether, 91 women participated in the research. Lifestyle information was collected, in addition to the analysis of clinical measures of cardiovascular risk and biochemical parameters. Unpaired Student's t-test, logistic regression, and Pearson's correlation were performed for data analysis, with a value of p <0.05 considered significant. Results: The prevalence of AO was 62.6%. Logistic regression showed that AO increased the chance of developing SAH by 2.9-fold. The same behavior was observed in the TG/HDL-c lipid ratio (3.93 ± 0.3 vs. 2.16 ± 0.2), representing an 82% increase in obese women. The present study also demonstrated that the best anthropometric parameter to analyze cardiovascular risk in the studied population was the waist/height ratio (AUC = 0.707). Conclusions: It can therefore be concluded that AO plays a significant role in the development of SAH and changes in lipid values that predict increased cardiovascular risk, configuring a strong influence factor for CVD.

Effects of high intensity-interval training on cardiovascular risk, body mass index and metabolic markers in healthcare workers / Efecto de entrenamiento por intervalos de alta intensidad sobre riesgo cardiovascular, índice de masa corporal y marcadores metabólicos en personal de salud

Background and Objectives: The obesity epidemic in Mexico has caused a health crisis. This places great importance in the identification of useful methods to manage it across all populations. In this present study we evaluate the effect of high intensity interval training in healthcare workers. Materials and Methods: An intervention was carried out that consisted in 60 sessions of high intensity interval training during a 12 week period aimed at health care workers working at the General Hospital in Montemorelos, Mexico. Variables regarding body composition, cholesterol and arterial blood pressure were evaluated for each individual both before and after the intervention. Pearson coefficients were estimated between the initial and final values. Results: 8 participants were included, 55.6% men aged 32.8 ± 10.9 years with a BMI of 31.69 ± 2.9. A statistically significant difference was found between the initial and final values ​​of weight, BMI, total cholesterol, mean arterial blood pressure, and cardiovascular risk at 10 years. Conclusions: These results reveal a significant decrease in our variables related to obesity in healthcare workers after a HIIT intervention in an uncontrolled setting. We recommend the further implementation of similar studies with greater sample size, intensity and duration to target obesity which is the root cause of chronic non-communicable diseases. Further studies are required to confirm the effect of this intervention in the prevention, treatment of obesity in health care workers and to describe its long term effects.

INTRODUCCIÓN: La obesidad juega un papel importante en las enfermedades crónicas no transmisibles que ha provocado una crisis de salud en México. Es de gran importancia encontrar métodos útiles para enfrentarla en todas las poblaciones. OBJETIVOS En el presente estudio evaluamos el efecto del entrenamiento por intervalos de alta intensidad en trabajadores de la salud. MATERIALES Y MÉTODOS: Se realizó una intervención que consistió en 60 sesiones de entrenamiento con intervalos de alta intensidad durante un período de 12 semanas dirigido a trabajadores de la salud que laboran en el Hospital General de Montemorelos, México. Se evaluaron las variables de composición corporal, colesterol y presión arterial de cada individuo antes y después de la intervención. Se estimaron coeficientes de Pearson entre los valores inicial y final. RESULTADOS: Se incluyeron 8 participantes de 32,8 ± 10,9 años con un IMC de 31,69 ± 2,9. Se encontró diferencia estadísticamente significativa entre los valores inicial y final de peso, IMC, colesterol total, presión arterial media y riesgo cardiovascular a los 10 años. CONCLUSIONES: Estos resultados revelan una disminución significativa de nuestras variables relacionadas con la obesidad en el personal de la salud tras una intervención HIIT en un entorno no controlado. Recomendamos la implementación adicional de estudios similares con mayor tamaño de muestra, intensidad y duración para abordar la obesidad.

Effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults with cardiovascular risk. A systematic review / Efectividad del ayuno intermitente sobre marcadores bioquímicos y antropométricos en adultos obesos con riesgo cardiovascular. Una revisión sistemática.

Background. Obesity is a problem present in almost all societies, which has led to the search for different methods to combat it. One of them is intermittent fasting (IF), characterized by periods without eating (16 to 24 hours), limited or no caloric intake, combined with normal eating windows. Target. To determine the effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults. Materials and methods. A systematic review was proposed that postulated to study blinded or open clinical trials of IA interventions, compared with a control group. The response variables were: systolic and diastolic blood pressure, total cholesterol, LDL, HDL and triglycerides, blood glucose, fat mass, weight, waist circumference, BMI and heart rate. The search and identification of studies was masked. The risks of bias for the Cochrane collaboration were assessed. They underwent meta-analysis (random effect), with R 4.0.0. Results. Six studies were included, involving 10-48 weeks of intervention with alternate-day fasting and time-restricted feeding, reporting some statistically significant changes for different variables. Conclusion. Intermittent fasting could intervene in the reduction of cardiovascular risk due to improvement in BMI and biochemical parameters.

Antecedentes. La obesidad es un problema presente en casi todas las sociedades, lo que ha conllevado a buscar distintos métodos para combatirla. Uno de ellos es el ayuno intermitente (AI), caracterizado por periodos sin ingesta (16 a 24 hr), ingesta calórica limitada o nula, combinada con ventanas de alimentación normal. Objetivo. Determinar la efectividad del ayuno intermitente sobre los marcadores bioquímicos y antropométricos en adultos obesos. Materiales y Métodos. Se planteó una revisión sistemática que postuló estudiar ensayos clínicos enmascarados o abiertos de intervenciones de AI, comparado con grupo control. Las variables de respuesta fueron: presión arterial sistólica y diastólica, colesterol total, LDL, HDL y triglicéridos, glicemia, masa grasa, peso, circunferencia de cintura, IMC y frecuencia cardiaca. La búsqueda e identificación de los estudios fue enmascarada. Se evaluaron los riesgos de sesgo de la colaboración Cochrane. Se sometieron a meta-análisis (efecto aleatorio), con R 4.0.0. Resultados. Se incluyeron 6 estudios, de 10-48 semanas de intervención con ayuno en días alternos y alimentación con restricción de tiempo, reportándose algunos cambios estadísticamente significativos para distintas variables. Los meta-análisis obtenidos muestran diferencias de medias estadísticamente significativas.  Conclusión. Existe evidencia que respalda un beneficio de AI a nivel de indicadores bioquímicos.

Incidencia de recién nacidos grandes para la edad gestacional y su asociación con diabetes mellitus gestacional y obesidad maternas. Estudio de cohorte en un hospital de Buenos Aires / Incidence of large-for-gestational-age newborns and its association with maternal gestational diabetes mellitus and obesity. Cohort study in a hospital in Buenos Aires

Resumen Introducción: existen dos términos para describir el crecimiento fetal excesivo: "grande para la edad gestacional" (GEG) y "macrosomía". GEG generalmente implica un peso al nacer superior al percentil 90 para una edad gestacional determinada. Objetivos: estimar la incidencia de recién nacidos GEG, y evaluar si la obesidad y la diabetes mellitus gestacional (DMG) son factores asociados. Materiales y métodos: estudio de cohorte retrospectivo de embarazadas -con y sin DMG- y sus recién nacidos vivos entre 2015 y 2018, evaluadas en el Hospital Italiano de la Ciudad Autónoma de Buenos Aires. La incidencia de recién nacidos GEG y de macrosomía se presentó como porcentajes e intervalos de confianza del 95% (IC 95%), así como sus complicaciones. Se utilizó regresión logística múltiple para evaluar si la DMG y la obesidad eran factores asociados a recién nacidos GEG. Resultados: la incidencia de GEG fue del 15,9% (IC 95%; 14,117,9) y de macrosomía del 6,7% (IC 95%; 5,5-8,1). La incidencia de recién nacidos GEG fue mayor en las mujeres con DMG y obesidad. La obesidad representó per se un mayor riesgo con y sin asociación con DMG. La obesidad, en presencia de DMG, incrementa la chance de recién nacidos GEG comparada con las mujeres sin DMG y sin obesidad (OR 2,41; p<0,001). Conclusiones: la DM y la obesidad materna incrementan el riesgo de GEG. Es importante implementar medidas preventivas e intervenciones en las mujeres en edad fértil con el objetivo de promover la salud de la madre y de su descendencia.

Abstract Introduction:two terms are used to describe excessive fetal growth: "large for gestational age" (LGA) and "macrosomia". LGA generally implies a birth weight greater than the 90th percentile for a given gestational age. Objectives: to estimate the incidence of LGA newborns and to assess whether obesity and gestational diabetes mellitus (GDM) are associated factors. Materials and methods: retrospective cohort study of pregnant women with and without GDM and their live newborns between 2015-2018 evaluated at the Italian Hospital in the City of Buenos Aires, Argentina. The incidence of LGA and macrosomia newborns is presented as percentages and 95% confidence intervals (95% CI), as well as their complications. Multiple logistic regression was used to assess whether GDM and obesity are factors associated with LGA newborns. Results: the incidence of LGA was 15.9% (IC 95%; 14.1-17.9) and of macrosomia 6.7% (IC 95%; 5.5-8.1). The incidence of LGA newborns was higher in women with GDM and obesity. Obesity represented a higher risk per se with and without association with GDM. Obesity, in the presence of GDM, increases the chance of LGA newborns compared to women with GDM and without obesity (OR 2.41; p<0.001). Conclusions:diabetes and maternal obesity increase the risk of LGA. It is important to implement preventive measures and interventions on women of childbearing age with the aim of promoting the health of the mother and her offspring.

Neck circumference as a predictor of gestational diabetes and risk of adverse outcomes in pregnancy of Brazilian woman with overweight and obesity

ABSTRACT Objective: To evaluate the association of neck circumference (NC) with gestational diabetes (GDM) and adverse outcomes in women with overweight and obesity. Subjects and methods: This prospective study included 132 (BMI > 25 kg/m2) pregnant women without and with GDM. Standardized questionnaire and biochemical/physical evaluation were performed during the 1st to 3rd trimester. Fifth-five women were evaluated regarding hypertension in pregnancy, type of delivery and neonatal complications (death, intensive care unit admission and hypoglycemia). Results: Women with (n = 61) and without (n = 71) GDM had similar mean (SD) pre-gestational BMI [30.3 (4.0) vs. 29.4 (3.5) kg/m2, p = 0.16]. Women with GDM were older [32 (6) vs. 28 (6) yrs, p < 0.001] and had greater NC [36.0 (2.7) vs. 34.5 (1.8) cm, p < 0.001]. NC was similar in women with GDM diagnosed in first or third trimester [p = 0.4] and was correlated with FPG [r 0.29, p = 0.01] and systolic [r 0.28, p = 0.001] and diastolic [r 0.25, p = 0.004] blood pressure. NC was associated with GDM [OR 1.25, 95%CI 1.03-1.52] adjusted for age, physical activity, education and familiar history of diabetes. In ROC analysis, the area under the curve was 0.655 and the cut-off value of 34.5 cm had 0.70 of sensitivity and 0.51 of specificity for GDM. Women who had NC ≥ 34.5 vs. < 34.5 cm had higher frequencies of hypertension [32.3 vs. 4.2%, p = 0.01]. Conclusions: In a group of pregnant women with overweight or obesity, NC can be a useful tool for identifying risk of GDM and obstetric adverse outcomes.

Binge eating disorder, frequency of depression, and systemic inflammatory state in individuals with obesity - A cross sectional study

ABSTRACT Objective: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Materials and methods: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 - Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results: Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling "stuffed", and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusions: Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.

Percepção de barreiras à prática de atividades físicas por pacientes diabéticos tipo 2 / Perception of barriers to the practice of physical activities by type 2 diabetic patients

O diabete melito está entre as principais causas de mortalidade no mundo e pode ser agravada pela inatividade física. O objetivo deste estudo descritivo transversal foi identificar as barreiras percebidas para a prática de atividade física sob a perspectiva dae pacientes diabéticos tipo 2. Participaram 220 pacientes (111 mulheres e 109 homens), com média de idade de 62,9 anos. Foram coletados índice de massa corporal, dados sociodemográficos e informações relacionadas ao histórico de doenças preexistentes. Para a análise das barreiras percebidas para a prática de atividades físicas, utilizou-se um questionário estruturado e validado para a população adulta brasileira proposto por Martins&Petroski. As barreiras foram analisadas individualmente e agrupadas em domínios ambiental, comportamental, físico e social. Em conclusão, as barreiras percebidas foram a falta de interesse (38,6%), cansaço físico (32,3%) e jornada de trabalho extensa (26,3%) e, assim, medidas devem ser adotadas visando minimizar os efeitos dessas barreiras e promover a atenção primária à saúde à essa população

Diabetes is among the leading causes of mortality in the world and can be aggravated by physical inactivity. This descriptive cross-sectional study aimed to identify the perceived barriers to the practice of physical activity from the perspective of type 2 diabetic patients. 220 diabetic patients participated in the research (111 women and 109 men), with a mean age of 62.9 years. Body mass index, sociodemographic data and information related to the history of preexisting diseases were collected. For the analysis of perceived barriers to the practice of physical activities, a structured and validated questionnaire for the Brazilian adult population proposed by Martins&Petroski was used. Barriers were analyzed individually and grouped into environmental, behavioral, physical and social domains. In conclusion, the main barriers perceived were lack of interest (38.6%), physical fatigue (32.3%) and long working hours (26.3%) and, them, measures should be taken to minimize the effects of these barriers, in order to promote primary health care in this population

Body Weight Loss is not Different between Patients with Digestion Gastrointestinal and Accessory Organs Cancer With High or low Neutrophils to Lymphocytes Ratio / Perda de Peso Corporal não é Diferente Entre Pacientes com Câncer Gastrointestinal e de Órgãos Acessórios da Digestão com Alta ou Baixa Relação Neutrófilos/Linfócitos

This study sought to assess if patients with cancer with high neutrophils to lymphocytes ratio (NLR) leads to body weight loss. A crosssectional study was performed in a public hospital. A total of 97 patients with digestion gastrointestinal and accessory organs cancers were evaluated. Body mass index (kg/m2) was calculated using the body weight (kg) divided by square of height (m) and body weight loss was obtained by percentage of body weight loss in the last months. The systemic inflammation was measured using the NLR and ≥6.5 values were considered as a high inflammation. It was found out that 11.3% of the patients have NLR ≥6.5. The NLR group ≥6.5 was younger than the NLR group <6.5 (NLR ≥6.5: 51.7 ± 14.1 vs. NLR <6.5: 61.9 ± 11.9 y, p=0.01), but without differences among sex, alcohol consumption, smoking, physical activity, body weight, body weight loss percentage and body mass index. In conclusion, it was found out that patients with digestion gastrointestinal and accessory organs cancers with NLR ≥6.5 did not differ in body weight loss when compared to patients with NLR <6.5. (AU)

Este estudo procurou avaliar se pacientes com câncer com alta razão neutrófilos/linfócitos (RNL) apresentam maior perda de peso corporal. Foi realizado um estudo transversal em um hospital público. Foram avaliados total de 97 pacientes com cânceres gastrointestinais e de órgãos acessórios da digestão. O índice de massa corporal (kg/m2) foi calculado usando o peso corporal (kg) dividido pelo quadrado da altura (m) e a perda de peso corporal foi adquirida pela porcentagem de perda de peso corporal nos últimos meses. A inflamação sistêmica foi medida pelo RNL e valores ≥6,5 foram considerados como alta inflamação. Nós encontramos que 11,3% dos pacientes têm RNL ≥6,5. O grupo RNL ≥6,5 é composto de pacientes mais jovens do que o grupo RNL <6,5 (RNL ≥6,5: 51,7 ± 14,1 vs. RNL <6,5: 61,9 ± 11,9 anos, p=0,01), mas sem diferenças entre sexo, consumo de álcool, tabagismo, atividade física, peso corporal, porcentagem de perda de peso corporal e índice de massa corporal. Em conclusão, nós observamos que pacientes com cânceres gastrointestinais e de órgãos acessórios da digestão com RNL ≥6,5 não diferiram na perda de peso corporal quando comparados com pacientes com RNL <6,5. (AU)

Interaction analysis of FTO and IRX3 genes with obesity and related metabolic disorders in an admixed Latin American population: a possible risk increases of body weight excess / Análisis de la interacción entre los genes FTO e IRX3 con obesidad y desórdenes metabólicos relacionados en una población mixta de América Latina: un posible aumento del riesgo de exceso de peso

Abstract Background: Fat Mass and Obesity-related (FTO) has been one of the genes consistently related to common obesity. Single nucleotide polymorphisms (SNPs) in FTO have been linked with the IRX3 gene. Aim: This study was designed by testing the hypothesis that: i) common SNPs in FTO and IRX3 are associated with obesity and related disorders; ii) there is significant linkage disequilibrium between both genes. Methods: A cross-sectional study was carried out on the Colombian Caribbean Coast. Anthropometric and biochemical variables were measured, and obesity and metabolic disorders were diagnosed. Four SNPs were genotyped: 3 at FTO locus (rs17817449, rs8050136, rs9939609) and one at IRX3 locus (rs3751723). LD between these SNPs was estimated. A logistic regression model was applied to estimate associations. Results: A total of 792 subjects were included. FTO and IRX3 were not in LD (D'≤ 0.03; R2≤ 0.03). TT genotype (rs9939609) was found to be associated with waist circumference (p= 0.04; adj-p= 0.01), and IRX3 SNP with Body Weight Excess (BWE) (OR= 1.06, adj-p= 0.03). One FTO-IRX3 haplotype was associated with BWE (G-A-A-T, rs17817449-rs8050136-rs9939609-rs3751723; OR= 0.67, p= 0.04). The statistical significance of these relations continued after admixture adjustment for a three-hybrid population (p= 0.03). Conclusions: FTO was related to waist circumference, and IRX3 was associated with BWE in Latin American adults. This relation remained statistically significant after an adjustment for sex, age, and genetic ancestry was performed. Despite that these genes were not in LD, findings of a haplotype involving FTO-IRX3 suggest a gene-gene interaction associated with an increased risk of BWE.

Resumen Introducción: FTO (Fat Mass and Obesity-related) se ha relacionado de manera consistente con la obesidad. Recientemente, Polimorfismos de Nucleótido Único (SNP) en este gen se han relacionado con el gen IRX3. Objetivo: Probar la hipótesis de que: i) SNPs en FTO e IRX3 están asociados con la obesidad y trastornos relacionados; ii) existe desequilibrio de ligamiento (LD) significativo entre ambos genes. Métodos: se realizó un estudio transversal en la costa caribe colombiana. Se valoraron variables antropométricas y bioquímicas, la obesidad y trastornos metabólicos. Se genotipificaron 4 SNPs: 3 en FTO (rs17817449, rs8050136, rs9939609) y uno en IRX3 (rs3751723). Se estimó el LD entre estos SNPs. Se aplicó un modelo de regresión logística para estimar asociaciones. Resultados: Se incluyeron 792 sujetos. FTO e IRX3 no se encontraron en LD (D' ≤0.03; R2 ≤0.03). El genotipo TT (rs9939609) se encontró asociado con la circunferencia de la cintura (p= 0.04; adj-p= 0.01), y el SNP IRX3 con el Exceso de Peso (EP) (OR= 1.06, adj-p= 0.03). Se encontró un haplotipo FTO-IRX3 asociado con EP (G-A-A-T, rs17817449-rs8050136-rs9939609-rs3751723; OR= 0.67, p= 0.04). Esta asociación persistió después del ajuste para una población mixta (p= 0.03). Conclusiones: FTO se encontró asociado con la circunferencia de la cintura e IRX3 con EP en adultos latinoamericanos. Estas asociaciones persistieron tras el ajuste por sexo, edad y ascendencia genética. Aunque estos genes no estaban en LD, los hallazgos de un haplotipo entre FTO-IRX3 sugieren una interacción gen-gen asociada con un mayor riesgo de EP.

Asociación de la hiperreactividad cardiovascular y la obesidad entre individuos sedentarios y activos / Association of Cardiovascular Hyperreactivity and Obesity between Sedentary and Active Individuals

RESUMEN Fundamento existen diversos estudios que muestran una relación de la hiperreactividad cardiovascular con algunos factores de riesgo cardiovascular, pero se hace necesario continuar evidenciando dicha relación. Objetivo: determinar la asociación de la hiperreactividad cardiovascular y la obesidad entre individuos sedentarios y activos en Cienfuegos. Métodos: se realizó un estudio descriptivo, transversal y correlacional en un universo de 80 individuos entre 18 y 30 años del municipio Cienfuegos, durante el año 2020. Las variables analizadas fueron: edad, sexo, color de la piel, nivel de sedentarismo, presión arterial basal con la prueba del peso sostenido, índice de masa corporal y cintura abdominal. Se utilizó Chi Cuadrado de Pearson para describir la asociación de las variables de estudio entre sujetos sedentarios y activos, así como la prueba T para la comparación de las medias. Nivel de significación p˂0,05. Los resultados se expresaron en tablas. Resultados: predominaron las edades de 18-24 años y el color de la piel blanca. El 76,3 % posee la condición de sedentarismo sobre los activos. El 65,6 % de los sedentarios correspondieron al sexo femenino. En las pruebas antropométricas más del 30 % eran sobrepeso-obeso y el 20 % presentaba cintura abdominal alterada, para ambas coexistió la condición de ser sedentarios. Los sedentarios presentaron valores de la media de las variables hemodinámicas superiores a los activos. El 73,8 % de los sedentarios fueron hiperreactivos cardiovasculares al contrario del estado de normorreactivo cardiovascular que estuvo presente en el 94,7 % de los activos. Conclusiones la condición de sedentarismo incrementa los valores de las variables hemodinámicas y antropométricas estudiadas.

ABSTRACT Background: there are several studies that show a relationship between cardiovascular hyperreactivity and some cardiovascular risk factors, but it is necessary to continue showing this relationship. Objective: to determine the association of cardiovascular hyperreactivity and obesity between sedentary and active individuals in Cienfuegos. Methods: a descriptive, cross-sectional and correlational study was carried out in a universe of 80 individuals between 18 and 30 years of age in the Cienfuegos municipality, during 2020. The variables analyzed were: age, sex, skin color, level of sedentary lifestyle, pressure baseline blood pressure with the sustained weight test, body mass index and abdominal waist. Pearson's Chi Square was used to describe the association of the study variables between sedentary and active individuals, as well as the T test for the comparison of means. Significance level p˂0.05. The results were expressed in charts. Results: ages 18-24 years old and white skin color predominated. 76.3 % have a sedentary lifestyle over assets. 65.6 % of the sedentary were female. In the anthropometric tests, more than 30 % were overweight-obese and 20 % had altered abdominal waist, for both the condition of being sedentary coexisted. The sedentary subjects presented mean values ​​of the hemodynamic variables higher than the active subjects. 73.8 % of the sedentary subjects were cardiovascular hyperreactive, as opposed to the normoreactive cardiovascular state that was present in 94.7 % of the active subjects. Conclusions: the condition of sedentary lifestyle increases the values ​​of the hemodynamic and anthropometric variables studied.

Efectos de los agonistas del receptor de péptido similar al glucagón tipo 1 como tratamiento en pacientes con obesidad y diabetes mellitus tipo 2 / Effects of glucagon-like peptide-1 receptor antagonist in the treatment of patients with obesity and Type 2 diabetes mellitus

Introducción: Recientemente se han descubierto nuevos medicamentos para el tratamiento de la diabetes tipo 2, con novedosos mecanismos de acción y menos efectos adversos. Dentro de ellos tenemos los análogos del péptido similar al glucagón tipo 1. Objetivo: Explicar la evidencia existente sobre los efectos del tratamiento con agonistas del receptor del péptido similar al glucagón tipo 1 en las personas con obesidad y diabetes mellitus tipo 2. Material y Métodos: Se realizó una revisión sistemática que incluyó estudios de los efectos de los agonistas del receptor del péptido similar al glucagón tipo1 como tratamiento en personas mayores de 12 años con obesidad y diabetes tipo 2. Se realizó una síntesis narrativa formal de los datos recogidos, no se realizó una síntesis estadístico formal. La calidad de evidencia para cada desenlace se determinó, según la metodología Grading of Recommendations Assessmet, Developmet and Evaluation. Resultados: La evidencia disponible demuestra que los agonistas del receptor del péptido similar al glucagón tipo 1, lograron una mayor disminución del peso corporal (-7,0 por ciento vs -2 por ciento) y de las cifras de hemoglobina glucosilada (HbA1c) (-0,40 por ciento vs -0,10 %) respecto al grupo placebo. Además, de una mayor reducción de la cintura abdominal. Conclusiones: La evidencia analizada muestra que los fármacos del tipo agonistas del receptor del péptido similar al glucagón tipo 1 tienen efectos beneficiosos en el tratamiento de las personas con obesidad y diabetes, disminuyendo el peso corporal y los valores de glucemia(AU)

Introduction: New drugs with novel mechanisms of action and fewer adverse effects have recently been discovered for the treatment of type 2 diabetes. Among them are glucagon-like peptide-1 analogues. Objective: To explain the existing evidence of the effects of treatment with glucagon-like peptide-1 receptor agonists in people with obesity and type 2 diabetes mellitus. Material and Methods: We conducted a systematic review that included studies on the effects of glucagon-like peptide -1 receptor agonists for the treatment of people older than 12 years with obesity and type 2 diabetes. A formal narrative synthesis of the collected data was performed, whereas a formal statistical synthesis was not performed. The quality of evidence for each outcome was determined according to the Grading of Recommendations Assessment, Development and Evaluation method. Results: The available evidence shows that glucagon-like peptide -1 receptor agonists achieved a greater reduction in body weight (-7,0 percent vs -2 percent) and glycosylated hemoglobin (HbA1c) (-0,40 percent vs -0,10 percent) compared to the placebo group. In addition, there was a greater reduction in abdominal waist circumference. Conclusions: The evidence analyzed shows that glucagon-like peptide -1 receptor agonists have beneficial effects in the treatment of people with obesity and diabetes, reducing body weight and glycemia values(AU)