Cirugía bariátrica y evolución de COVID-19 / Bariatric surgery and evolution of COVID-19

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

Caracterización epidemiológica de pacientes diabéticos e hipertensos en consultorio en Quinta Normal, 2018-2019 / Epidemiological features of patients ascribed to a primary care cardiovascular health program in Santiago, Chile

BACKGROUND: Hypertension and diabetes are highly prevalent conditions in Chilean adults. AIM: To describe the demographic and clinical profiles, risk factors and complications associated with arterial hypertension (AH) and diabetes mellitus (DM) in patients ascribed to a cardiovascular health program at a public primary health care center in Santiago. MATERIAL AND METHODS: Review of medical records of 583 patients aged 37 to 95 years (56% women). Gender, age, smoking habits, blood pressure, glycated hemoglobin levels, LDL cholesterol and triglycerides levels, nutritional status in the last control carried out, and associated cardiovascular complications were recorded. RESULTS: Thirty four percent (201 participants) and 36% (210 participants) had a decompensated DM and AH, respectively. Dyslipidemia was the main associated cardiovascular risk factor. The prevalence of obesity was 43% (249 participants). Twenty percent had chronic kidney disease and 13% had diabetic retinopathy. CONCLUSIONS: These patients have a high frequency of obesity, dyslipidemia, and chronic kidney disease.

Relación entre la obesidad y la COVID-19 / Relationship between obesity and COVID - 19

Existen evidencias crecientes que indican que la obesidad actúa como factor de riesgo independiente para padecer la COVID-19, los pacientes obesos tienen mayor incidencia de complicaciones, tiempo de hospitalización y riesgo de muerte. El objetivo de este trabajo es exponer la relación entre la obesidad y las formas graves de COVID-19, así como exponer los posibles mecanismos implicados. Se realiza una revisión de la literatura mundial y de las publicaciones nacionales referidas a la obesidad y la COVID-19. Se identifican las características que hacen a los obesos más susceptibles a infectarse por SARS-CoV-2 y a tener peor pronóstico. Se concluye que la obesidad constituye un desafío permanente en nuestro medio, que su prevención, tratamiento temprano y oportuno, permitirían reducir los tiempos de hospitalización, evolución desfavorable y mortalidad por COVID-19 grave(AU)

There is growing evidence that obesity acts as an independent risk factor for Covid-19. Obese patients have higher incidence of complications, hospitalization time and risk of death. The objective of this paper is to describe the relationship between obesity and severe forms of COVID 19, as well as to expose the possible mechanisms involved. A review of the world literature and national publications referring to obesity and COVID-19 is carried out. The characteristics that make obese people more susceptible to being infected by SARS-COV-2 and having a worse prognosis are identified. It is concluded that obesity constitutes a permanent challenge in our environment. Early and timely prevention would allow reducing hospitalization times, unfavorable evolution and mortality due to severe Covid-19(AU)

O Efeito Direto do Índice de Massa Corporal nos Resultados Cardiovasculares entre Participantes sem Obesidade Central pela Estimativa por Máxima Verossimilhança Direcionada / The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. Resultados: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. Conclusão: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886)

Background: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. Objective: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. Methods: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. Results: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. Conclusion: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886)

Factores de riesgo para enfermedad cerebrovascular en el adulto mayor / Risk Factors for Cerebrovascular Disease in the Older Adult

Introducción: La vejez está subvalorada, poco se piensa en el bienestar físico y psicosocial del anciano. La enfermedad cerebrovascular tiene como factores de riesgo comorbilidades como la hipertensión arterial, la diabetes mellitus, la dislipidemia, cardiopatías o malos estilos de vida como el consumo de cigarrillo, la obesidad y la poca actividad física, todos estos comunes en esta etapa de la vida. Objetivo: Identificar los factores de riesgo que presentan los adultos mayores para sufrir enfermedad cerebrovascular de un centro gerontológico de la ciudad de Medellín. Métodos: Fue una investigación descriptiva, de tipo transversal; se indagaron 37 adultos mayores con historias clínicas y exámenes de laboratorio. Se midieron los niveles de hemoglobina glicosilada, colesterol total, colesterol de baja densidad, colesterol de alta densidad y triglicéridos. Resultados: Se evidenció que la población era en su mayoría de sexo masculino con 51,4 por ciento y el sexo femenino con 48,6 por ciento; con rango de edad entre 60 y 70 años el 51,4 por ciento. Los factores de riesgo más relevantes fueron el índice de masa corporal mayor o igual a 25 con (75,7 por ciento), hipertensión arterial y no realizar actividad física. Conclusiones: Se logró determinar los principales factores de riesgo que tienen estos adultos mayores para sufrir enfermedad cerebrovascular; con resultados algunos similares y otros diferentes a estudios a nivel mundial. Con actividades de promoción y prevención se pueden intervenir estilos de vida de la población(AU)

Introduction: Old age is undervalued; little is thought about the physical and psychosocial well-being of the elderly. Among the risk factors of cerebrovascular disease, there are comorbidities, such as high blood pressure, diabetes mellitus, dyslipidemia and cardiopathies, or poor lifestyles like cigarette smoking, obesity and little physical activity, all of which are common at this stage of life. Objective: To identify, in a gerontological center in Medellín City, the risk factors that older adults present for being affected by cerebrovascular disease. Methods: This was a descriptive and cross-sectional research carried out with 37 older adults with medical antecedents and laboratory tests. The levels of glycated hemoglobin, total cholesterol, low-density and high-density cholesterol, as well as triglycerides were measured. Results: It was evidenced that the population was mostly male (51.4 por ciento), while females accounted for 48.6 por ciento. Their age range was mostly between 60 and 70 years (51.4 por ciento). The most relevant risk factors were body mass index greater than or equal to 25 (75.7 por ciento), arterial hypertension and not doing any physical activity. Conclusions: It was possible to determine the main risk factors for these older adults being affected by cerebrovascular disease; in this respect, some results were similar to and others were different from studies worldwide. With promotion and prevention activities, lifestyles of the population can be intervened(AU)

Cardiovascular Risk Profile of a Young Adult Women Population Assisted in Primary Care

Abstract Background Although cardiovascular disease is a major cause of death among women, cardiovascular risk assessment in young women is frequently postponed due to a number of factors. Objectives To assess cardiovascular risk of young adult women living in one of Rio de Janeiro's Family Health Strategy geographical units in the city's central area. Materials and Methods populational, cross-sectional study with adults between 20 and 50 years old. Sociodemographic characteristics such as educational level and employment status were recorded. Anthropometric measurements, traditional cardiovascular risk factors, gynecological and gestational history, and selected laboratory exams were assessed. The bivariate analysis compared the baseline characteristics of the population between genders and the prevalence of cardiovascular risk factors in women according to educational level and occupation status, using non-paired Student's t-test for normal continuous variables, Mann-Whitney test for asymmetrical continuous variables, and chi-square test for categorical variables. A significance level of 5% (p < 0.05) was adopted. Results A total of 710 individuals were enrolled. In women, who comprised 59.7% of our sample, central obesity and a sedentary lifestyle were more prevalent, whereas smoking and hypertension were less observed. However, women with lower educational status had a higher prevalence of smoking and hypertension. In hypertensive women, factors such as early menopause, higher prevalence of hypertensive disorders of pregnancy and higher number of pregnancies were noticed. Conclusion An adverse cardiovascular risk profile in our population of young women was particularly influenced by central obesity, sedentary lifestyle, hypertensive disorders of pregnancy and lower educational status.

Carga respiratória em obesos e jovens asmáticos: um estudo da cinética diafragmática / Respiratory burden in obese and young asthmatics: a study of diaphragmatic kinetics

RESUMO Objetivo O objetivo deste estudo foi avaliar a cinética diafragmática, a função respiratória e a dosagem sérica de leptina e citocinas inflamatórias (IL-6 e TNF-α) em três grupos clínicos: obeso, asmático e saudável. Métodos Estudo clínico-exploratório realizado com 73 jovens (12-24 anos, sendo 42,5% do sexo masculino) alocados em três grupos: obesidade (GO, n = 33), índice de massa corporal (IMC z-score) ≥ + 2 e asmáticos leves controlados (GA, n = 26), classificados pela GINA, e grupo controle saudável (GC, n = 14). Os participantes foram submetidos à ultrassonografia diafragmática, espirometria, pressão respiratória máxima, níveis séricos de leptina e níveis de IL-6 e TNF-α em hemocultura total. Resultados A espessura do diafragma foi maior no GO em comparação ao GA e GC (2,0 ± 0,4 vs 1,7 ± 0,5 e 1,6 ± 0,2, respectivamente, com p < 0,05). A ventilação voluntária máxima (VVM) foi significativamente menor no GO e GA em relação ao GC (82,8 ± 21,4 e 72,5 ± 21,2 vs 102,8 ± 27,3, respectivamente, com p < 0,05). O GO tem a maior taxa de leptina entre todos os grupos (com os outros dois grupos, p < 0,05). Os três grupos tinham níveis semelhantes de TNF-α e IL-6. Conclusão A hipertrofia muscular encontrada no diafragma de indivíduos obesos pode ser justificada pelo aumento do trabalho respiratório imposto pela condição crônica da doença. Esse aumento de espessura não ocorreu em asmáticos leves controlados. Os marcadores IL-6 e TNF-α não detectaram evidências de inflamação muscular, embora fosse esperado que a leptina estivesse alterada em indivíduos obesos. Pacientes obesos e asmáticos apresentaram menor resistência pulmonar do que os saudáveis.

ABSTRACT Objective The aim of this study was to assess the diaphragm kinetics, respiratory function, and serum dosage of leptin and inflammatory cytokines (IL-6 and TNF-α) in three clinical groups: obese, asthmatic, and healthy. Methods This is a clinical exploratory study performed on 73 youths (12-24 years of age, 42.5% male) allocated into three groups: obesity (OG, n=33), body mass index (BMIz-score) ≥ +2, asthmatic (AG, n=26) controlled mild asthmatics, classified by GINA, and Healthy Control Group (CG, n=14). The participants were subjected to diaphragmatic ultrasound, spirometry, maximal respiratory pressure, serum leptin levels, and IL-6 and TNF-α whole blood cell culture levels. Results Diaphragm thickness was higher in OG in comparison to AG and CG (2.0±0.4 vs 1.7±0.5 and 1.6±0.2, both with p<0.05). Maximal voluntary ventilation (MVV) was significantly lower in OG and AG in relation to the CG (82.8±21.4 and 72.5±21.2 vs 102.8±27.3, both with p<0.05). OG has the highest leptin rate among the groups (with the other two groups had p<0.05). All groups had similar TNF-α and IL-6 levels. Conclusion The muscular hypertrophy found in the diaphragm of the obese individuals can be justified by the increase in respiratory work imposed by the chronic condition of the disease. Such increase in thickness did not occur in controlled mild asthmatics. The IL-6 and TNF-α markers detected no evidence of muscle inflammation, even though leptin was expected to be altered in obese individuals. Both obese and asthmatic patients had lower pulmonary resistance than the healthy ones.

Obesidade como fator agravante da COVID-19 em adultos hospitalizados: revisão integrativa / Obesidad como factor agravante de COVID-19 en adultos hospitalizados: revisión integradora / Obesity as an aggravating factor of COVID-19 in hospitalized adults: an integrative review

Resumo Objetivo: Identificar, na literatura científica, a relação da obesidade como fator de risco agravante para a morbidade por COVID-19. Métodos: Trata-se de um estudo bibliográfico, tipo revisão integrativa de literatura, nos idiomas português, inglês e espanhol, por meio da estratégia PICo, em cinco bases de dados,PubMed, Scopus, Web of Science, Embasee BVS, realizada de maio a junho de 2020. Os critérios de inclusão adotados foram: artigos primários realizados com adultos; disponíveis na íntegra; publicados durante o período de 2019 a 2020; nos idiomas português, inglês e espanhol. Os critérios de exclusão foram: relato de casos; casos clínicos; dissertações; teses; os já selecionados na busca em outra base de dados e que não respondessem à questão da pesquisa. Resultados: A seleção resultou em noveestudos, sendo que quatro estudos - 44,4% (E3, E5, E6 e E7) - apresentaram a prevalência de obesidade em adultos hospitalizados por COVID-19, dois estudos - 22,2% (E6, E9) - associaram a obesidade ao desenvolvimento da COVID-19 grave, três estudos - 33,3% (E1, E4 e E7) - associaram a obesidade à necessidade de ventilação mecânica e três estudos - 33,3% (E2, E4 e E8) - associaram a obesidade à mortalidade por COVID-19. Conclusão: A obesidade trata-se de uma doença crônica não transmissível, sendo um fator de risco considerado importante para o agravamento da doença COVID-19, no entanto, é passível de prevenção, pois hábitos saudáveis de vida podem reduzir o quadro grave de infecção por COVID-19.

Resumen Objetivo: Identificar en la literatura científica la relación de la obesidad como factor de riesgo agravante para la morbilidad por COVID-19. Métodos: Se trata de un estudio bibliográfico, tipo revisión integradora de literatura, en idioma portugués, inglés y español, por medio de la estrategia PICO, en cinco bases de datos: PubMed, Scopus, Web of Science, Embase y BVS, realizada de mayo a junio de 2020. Los criterios de inclusión adoptados fueron: artículos primarios realizados con adultos, con texto completo disponible, publicados durante el período de 2019 a 2020, en idioma portugués, inglés y español. Los criterios de exclusión fueron: relato de casos, casos clínicos, tesis de maestría y doctorado, los artículos ya seleccionados en la búsqueda en otra base de datos y los que no respondieran la pregunta de investigación. Resultados: La selección tuvo como resultado nueve estudios, de los cuales cuatro — 44,4% (E3, E5, E6 y E7) — presentaron prevalencia de obesidad en adultos hospitalizados por COVID-19; en dos estudios — 22,2% (E6, E9) — se relacionó la obesidad con el desarrollo de COVID-19 grave; en tres estudios — 33,3% (E1, E4 y E7) — se relacionó la obesidad con la necesidad de ventilación mecánica; y en tres estudios — 33,3% (E2, E4 y E8) — se relacionó la obesidad con la mortalidad por COVID-19. Conclusión: La obesidad se trata de una enfermedad crónica no transmisible y es considerada un factor de riesgo importante para el agravamiento de la enfermedad COVID-19. Sin embargo, la prevención es posible, ya que los hábitos de vida saludables pueden reducir el cuadro grave de infección por COVID-19.

Abstract Objective: To identify, in scientific literature, the relationship of obesity as an aggravating risk factor for morbidity by COVID-19. Methods: This is a bibliographic and integrative literature review study, in Brazilian Portuguese, English and Spanish languages, through PICo strategy, in the PubMed, Scopus, Web of Science, Embase and VHL databases, held from May to June 2020. Primary articles conducted with adults, available in full, published during the period 2019 to 2020, in Brazilian Portuguese, English and Spanish were included. Case reports, clinical cases, dissertations, theses, the already selected in the search in another database and that did not answer the question of the search were excluded. Results: The selection resulted in nine studies. Four studies - 44.4% (E3, E5, E6 and E7) - presented the prevalence of obesity in adults hospitalized by COVID-19. Two studies - 22.2% (E6, E9) - associated obesity with the development of severe COVID-19. Three studies - 33.3% (E1, E4 and E7) - associated obesity with the need for mechanical ventilation. Three studies - 33.3% (E2, E4 and E8) - associated obesity with mortality due to COVID-19. Conclusion: Obesity is a chronic non-communicable disease, being a risk factor considered important for the worsening of COVID-19 disease, however, it is preventable, because healthy lifestyle habits can reduce the severe picture of COVID-19 infection.

Obesity as a predictive factor for chronic kidney disease in adults: systematic review and meta-analysis

Chronic kidney disease (CKD) is one of the main chronic diseases affecting the world population due to its high prevalence and increasing morbidity. Similarly, obesity gained the interest of the scientific community as it directly or indirectly increases mortality from cardiovascular causes, and its prevalence characterizes a pandemic. The objective of this study was to investigate obesity measured by body mass index as a predictor for end-stage renal disease in the general adult population. A systematic review and meta-analysis was carried out by searching 10 databases for prospective or retrospective cohort studies, with no restrictions on the language of publication, including adults with obesity without previous renal disease and who evolved to CKD (diagnosed by estimated glomerular filtration rate below 60 mL&mac_middot;min-1&mac_middot;(1.73 m2)-1 over the follow-up period. The R software and Meta package were used for data analysis. After removing duplicates, 5431 studies were submitted to the steps of the systematic review, and 21 articles were included in the data analysis. In total, 3,504,303 patients, 521,216 with obesity, and an average follow-up time of 9.86 years were included. The relative risk of obese people for developing CKD in the random effects model was 1.81 (95%CI: 1.52-2.16). The evidence found in this meta-analysis confirmed that obese people are at higher risk of developing CKD that the non-obese population (1.81 times higher), with obesity being a priority risk factor in preventive actions.

Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study

OBJECTIVES: We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS: COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS: Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION: Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.

Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement / El índice de masa corporal se asocia a bajo gasto cardiaco postoperatorio de pacientes sometidos a reemplazo valvular aórtico

Abstract Background: Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective: The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods: A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results: 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion: BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Resumen Antecedentes: El sobrepeso y la obesidad (O/O) generan lipotoxicidad de la fibra cardíaca y aumentan la incidencia y progresión de la estenosis de la válvula aórtica. El síndrome de bajo gasto cardíaco (SBGC) es una complicación postquirúrgica de la cirugía de reemplazo de válvula aórtica (RVA). Objetivo: Investigar si el índice de masa corporal kg/m2 (IMC) es un factor de riesgo asociado con SBGC y mortalidad en el postoperatorio de RVA. Métodos: Se diseñó un estudio de cohorte histórico, que incluyó pacientes con estenosis aórtica importante (EAI), que fueron sometidos a RVA. Resultados: Se incluyeron 152 pacientes, 45 (29.6%), con peso normal (N), 60 tenían sobrepeso (39.5%) y 47 obesos (30.9%). La prevalencia de hipertensión sistémica (HT) fue mayor en O/O (p < 0.0001). La incidencia de SBGC fue del 44.7%, siendo más frecuente en los grupos O/O en comparación con el grupo N, 43.3%, 68.1%, 22.2% respectivamente, (p < 0.05 en sobrepeso y p < 0.0001 en obesos). Al evaluar la presencia o ausencia de SBGC asociado con el IMC como una variable numérica, encontramos que las mujeres, HT, IMC, masa ventricular izquierda y tamaño de la válvula, se asociaron con SBGC (p < 0.02, p < 0.02, p < 0.001, p < 0.032, p < 0.045, respectivamente). La mortalidad fue mayor en pacientes con SBGC (p < 0.02). El modelo multivariado mostró que el IMC fue un factor de riesgo independiente asociado a SBGC [OR 1.21 (IC 95% 1.08-1.35), p < 0.001]. Conclusión: El IMC es un factor de riesgo asociado a SBGC en el postoperatorio de RVA en pacientes con EAI.

Larger patients shouldnt have fewer options: urethroplasty is safe in the obese

ABSTRACT Objective To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty. Material and Methods We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival. Results Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036). Conclusion Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.

Linking socioeconomic inequalities and type 2 diabetes through obesity and lifestyle factors among Mexican adults: a structural equations modeling approach / Asociación entre las inequidades socioeconómicas y la diabetes tipo 2 mediada por la obesidad y factores del estilo de vida en adultos mexicanos: un enfoque de modelos de ecuaciones estructurales

Abstract: Objective: To assess the association between type 2 diabetes (DM2) and socioeconomic inequalities, mediated by the contribution of body mass index (BMI), physical activity (PA), and diet (diet-DII). Materials and methods: We conducted a cross-sectional analysis using data of adults participating in the Diabetes Mellitus Survey of Mexico City. Socioeconomic and demographic characteristics as well as height and weight, dietary intake, leisure time activity and the presence of DM2 were measured. We fitted a structural equation model (SEM) with DM2 as the main outcome, and BMI, diet-DII and PA served as mediator variables between socioeconomic inequalities index (SII) and DM2. Results: The prevalence of DM2 was 13.6%. From the fitted SEM, each standard deviation increases in the SII was associated with increased scores of DM2 (β=0.174,P<0.001). Conclusion: The results in the present study show how high scores in the index of SII may influence the presence of DM2.

Resumen: Objetivo: Evaluar la asociación entre diabetes tipo 2 y las inequidades socioeconómicas (IS), mediada por la contribución del índice de masa corporal (IMC), actividad física (AF) y dieta (dieta-DII). Material y métodos: Se realizó un análisis transversal utilizando datos de la Encuesta de Diabetes Mellitus de la Ciudad de México. Se midieron las características sociodemográficas, altura, peso, ingesta dietética, actividad de tiempo libre y presencia de diabetes. Se ajustó un modelo de ecuaciones estructurales (MEE) con diabetes como resultado principal, e IMC, dieta-DII y PA sirvieron como variables mediadoras entre el IS y la diabetes. Resultados: La prevalencia de diabetes fue de 13.6%. A partir del MEE ajustado, cada aumento de la desviación estándar en el IS se asoció con un aumento en las puntuaciones de diabetes (β=0.174,P<0.001). Conclusión: Los resultados en el presente estudio muestran cómo los puntajes altos en las IS pueden influir en la presencia de diabetes.

Proteína C reactiva ultrasensible y riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 / Ultrasensitive reactive C protein and cardiovascular risk in patients with type 2 diabetes mellitus

Objetivo: describir el riesgo cardiovascular de pacientes con diabetes mellitus tipo 2 (DM2), según los valores de proteína C reactiva ultrasensible (PCR-us). Material y métodos: estudio descriptivo transversal, realizado en el Patronato del Diabético de zona 1, Ciudad de Guatemala, en el cual participaron 196 pacientes mayores de 50 años de edad, obteniéndose características sociodemográficas, medidas antropométricas. Además, se tomaron muestras de sangre que fueron procesadas en iCroma ll para determinar los valores de Proteína C reactiva ultrasensible (PCR-us). Resultados: los pacientes que aceptaron formar parte del estudio, tuvieron una media de edad de 62±8.62 DE; 74.4% (146) fueron del sexo femenino; 54% (106) eran católicos y el 82.1% (161), residían en la Ciudad de Guatemala. El estado nutricional fue normal en el 26% (50), el 11% (21) tenía sobrepeso y 63% (125), obesidad. Para índice cintura cadera (ICC) con respecto al sexo femenino, se obtuvo una media de 0.89±0.05 DE y una media 0.97±0.05 DE del sexo masculino. Respecto al riesgo cardiovascular, se obtuvo una media en valores de PCR-us de 2.9±2.8 DE, con 76% (148) de los pacientes en riesgo cardiovascular moderado/alto. Conclusiones: los valores de PCR-us tuvieron una media de 2.9±2.8 DE y 8 de cada 10 pacientes están en riesgo moderado/alto. De los pacientes estudiados, 7 de cada 10 fueron mujeres, con una media para a edad de 62 años. Se encontraron 7 de cada 10 con sobrepeso u obesidad, con una media para índice cintura cadera con respecto al sexo elevado.

Objective: to describe the cardiovascular risk of patients with type 2 diabetes mellitus, according to the values of ultrasensitive C-reactive protein (PCR-us). Material and methods: descriptive cross-sectional study, carried out on 196 patients over 50 years of age, from the Diabetic Board of Trustees in Zone 1, Guatemala. Data on sociodemographic characteristics, anthropometric measurements and blood were obtained. The blood samples were processed in iCroma ll to determine the values of ultrasensitive reactive Protein C (PCR-us). Results: the patients who accepted to be part of the study had a mean age of 62 ± 8.62 SD years; 74.4% (146) were female; 54% (106) were catholic, and 82.1% (161) resided in Guatemala City. Nutritional status was normal in 50 patients (26%), 21, overweight (11%) and 125, obese (63%). For the waisthip index, with respect to the female, an average of 0.89 ± 0.05 SD and for males, an average 0.97 ± 0.05 SD were obtained. Regarding cardiovascular risk, an average in PCR-us values of 2.9 ± 2.8 SD was obtained; 76% (148) of patient were at moderate / high cardiovascular risk.

Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes - results from a retrospective multicenter study

ABSTRACT Objective The aim of this study was to evaluate the impact of pre-pregnancy body mass index (BMI) on pregnancy outcomes in women with gestational diabetes (GD). Subjects and methods Retrospective multicenter study using data from the Portuguese National Register. We included women with GD with a singleton pregnancy. GD diagnosis was according to the International Association of the Diabetes and Pregnancy Study Group criteria. Women were divided into groups according to their pre-pregnancy BMI: < 18.5 kg/m2 (underweight), ≥ 18.5 and < 25.0 kg/m2 (normal weight), ≥ 25 and < 30 kg/m2 (overweight) and ≥ 30 kg/m2 (obese). Results We included 3,103 pregnant women with GD, 29.6% (n = 918) were overweight and 27.3% (n = 846) were obese. Compared to normal weight, the overweight and obese groups had a higher percentage of gestational hypertension (4.0% and 8.5% vs. 2.1%), cesarean delivery (32.8% and 41.3% vs. 27.9%), macrosomia (3.9% and 6.7% vs. 2.4%), and large for gestational age (LGA) newborns (8.3% and 13.5% vs. 6.0%). Obesity increased the risk of gestational hypertension (OR 4.5, p < 0.001), preeclampsia (OR 1.9, p = 0.034), cesarean delivery (OR 2.0, p < 0.001), macrosomia (OR 3.1, p < 0.001) and LGA (OR 2.3, p < 0.001). Conclusion In pregnant women with GD, pregnancy complications increase with pre-pregnancy BMI. In obese women, appropriate diet and counseling prior to gestation and more aggressive medical intervention during pregnancy are needed in order to prevent macrosomic and LGA newborns and to reduce maternal complications.

Relationship between anthropometric indicators and risk factors for cardiovascular disease in adults and older adults of Rio Branco, Acre / Relação de indicadores antropométricos com fatores de risco para doença cardiovascular em adultos e idosos de Rio Branco, Acre

ABSTRACT OBJECTIVE To analyze the association between anthropometric variables and cardiovascular risk factors in adults and older adults of Rio Branco, Acre. METHODS A population-based cross-sectional study with 641 adults and 957 older adults was conducted. The statistical analyses consisted of the distribution of anthropometric variables according to the cardiovascular risk factors by frequency and dispersion measures. Pearson's correlation coefficient and prevalence ratios (PR) were estimated with their respective 95% confidence intervals (95%CI) using the SPSS ® version 20.0. RESULTS Moderate correlations were obtained in adult men for waist-hip ratio and total cholesterol (r = 0.486; p < 0.001) and for waist-hip and triglyceride ratios (r = 0.484; p < 0.001). The highest prevalence of hypertension and diabetes in adults were observed in men; in the older adults, the prevalence of hypertension was above 65% in both sexes. The prevalence of dyslipidemia was above 78% in obese adults and older adults. When analyzing the associations, a higher strength of association was found between arterial hypertension and waist-to-stature ratio (PR = 13.42; 95%CI 12.58-14.31) and body mass index greater than 30 kg/m 2 (PR = 6.61; 95%CI 6.34-6.89) in adult men. In the analysis of diabetes, the waist-hip ratio presented greater robustness in the association for women (PR = 7.53; 95%CI 6.92-8.20) and men (PR = 9.79; 95%CI 9.14-10.49). CONCLUSION Anthropometric variables are important predictors of cardiovascular risk; however, their assessments should be performed independently, according to sex and age group.

RESUMO OBJETIVO Analisar a associação entre variáveis antropométricas e os fatores de risco cardiovascular na população de adultos e idosos de Rio Branco, Acre. MÉTODOS Estudo transversal de base populacional com 641 adultos e 957 idosos. As análises estatísticas consistiram na distribuição das variáveis antropométricas segundo os fatores de risco cardiovascular por medidas de frequência e dispersão. Foram calculadas a correlação de Pearson e razões de prevalência (RP) com seus respectivos intervalos de confiança de 95% (IC5%), empregando as rotinas do SPSS ® versão 20.0. RESULTADOS Correlações moderadas foram obtidas nos adultos homens para relação cintura-quadril e colesterol total (r = 0,486; p < 0,001) e para relação cintura-quadril e triglicerídeos (r = 0,484; p < 0,001). As maiores prevalências de hipertensão arterial e diabetes nos adultos foram observadas nos homens; já nos idosos, as prevalências de hipertensão ficaram acima de 65% em ambos os sexos. As prevalências de dislipidemia ficaram acima de 78% nos indivíduos obesos adultos e idosos. Ao analisar as associações, constatou-se maior força de associação entre hipertensão arterial e relação cintura-estatura (RP = 13,42; IC95% 12,58-14,31) e com índice de massa corporal maior que 30 kg/m 2 (RP = 6,61; IC95% 6,34-6,89) nos homens adultos. Na análise para diabetes, a relação cintura-quadril apresentou maior robustez na associação para mulheres (RP = 7,53; IC95% 6,92-8,20) e homens (RP = 9,79; IC95% 9,14-10,49). CONCLUSÃO As variáveis antropométricas são importantes preditores de risco cardiovascular; no entanto, suas avaliações devem ser feitas de forma independente, segundo sexo e grupo etário.

Epidemiology of artherial hypertension in pregnants / Epidemiologia da hipertensão arterial em gestantes

ABSTRACT Objective To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. Methods Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. Results Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). Conclusion After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.

RESUMO Objetivo Pesquisar os dados epidemiológicos da hipertensão arterial em gestantes, bem como identificar seus possíveis eventos associados. Métodos A coleta de dados foi realizada no ambulatório do pré-natal de alto risco e na enfermaria da maternidade em hospital público da cidade de São Paulo, nos períodos matutino e vespertino, de outubro de 2015 a julho de 2016. Foi aplicado um questionário com 22 perguntas elaborado pelos pesquisadores. A margem de erro foi de 5% e o nível de confiança, de 95%. Para o cálculo, foram usados o teste de igualdade de duas proporções, a correlação de Pearson e o teste de ANOVA. Resultados Dentre as entrevistadas, 43% tinham hipertensão crônica, 33,3% se apresentaram com até 20 semanas de gestação, 23,7% se apresentaram após a 20ª semana da gestação, 62,3% tinham idade entre 18 e 35 anos, 78,1% tinham antecedente familiar com hipertensão arterial, 11,4% com idade entre 36 a 45 anos estavam na primeira gestação, e 26,3% com a mesma idade estavam a partir da segunda gestação. Dentre as afecções associadas, prevaleceu o diabetes com 50%; 22,2% se tratavam de obesidade, e dos alimentos mais escolhidos para consumo entre as gestantes, 47,5% possuíam alto teor energético (processados/ultraprocessados). Conclusão Após análise epidemiológica no resultado da prevalência da hipertensão arterial, foram encontradas gestantes com hipertensão arterial crônica, hipertensão arterial preexistente descoberta durante a gestação e doença hipertensiva específica da gestação. Em relação aos possíveis fatores associados à hipertensão arterial, foram encontrados: idade mais elevada, antecedentes familiares de hipertensão, preexistência de hipertensão, gestações tardias, diabetes, obesidade e frequente consumo de alimentos processados/ultraprocessados.

Body mass index, asthma, and respiratory symptoms: a population-based study / Índice de massa corpórea, asma e sintomas respiratórios: um estudo de base populacional

ABSTRACT Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.

RESUMO Objetivo: Estimar a prevalência de sintomas respiratórios e asma de acordo com o índice de massa corpórea (IMC) em indivíduos com idade ≥ 40 anos e avaliar os fatores associados ao relato de diagnóstico médico de asma. Métodos: Estudo transversal de base populacional realizado no município de Florianópolis (SC), com coleta domiciliar de dados e processo de amostragem probabilístico. Foram coletadas informações demográficas, assim como sobre relato de diagnóstico médico de asma, sintomas respiratórios, medicações em uso e comorbidades. Também foram realizadas medidas antropométricas e espirometria pré- e pós-broncodilatador. O IMC foi categorizado em normal (IMC < 25 kg/m2), sobrepeso (25 kg/m2 ≥ IMC < 30 kg/m2) e obesidade (IMC ≥ 30 kg/m2). Resultados: Foram avaliados 1.026 indivíduos, 274 (26,7%) com IMC normal, 436 (42,5%) com sobrepeso e 316 (30,8%) obesos. A prevalência de diagnóstico médico de asma foi de 11,0%. A prevalência de obesidade foi maior em mulheres (p = 0,03) e em entrevistados com escolaridade < 4 anos (p < 0,001) ou com renda familiar entre 3-10 salários mínimos. Obesos, quando comparados com aqueles com sobrepeso e peso normal, relataram mais frequentemente diagnóstico médico de asma (16,1%, 9,9% e 8,0%, respectivamente; p = 0,04), dispneia (35,5%, 22,5% e 17,9%, respectivamente; p < 0,001) e sibilos no último ano (25,6%, 11,9% e 14,6%, respectivamente; p < 0,001). Esses resultados foram independentes do status tabágico. Além disso, obesos tinham uma chance três vezes maior de relato de diagnóstico médico de asma do que não obesos (p = 0,005). Conclusões: Houve associação significativa entre o relato de diagnóstico médico de asma em indivíduos com idade ≥ 40 anos e IMC ≥ 30 kg/m2. Ser obeso triplicou a chance de diagnóstico médico de asma.

Safety and effectiveness of laparoscopic Y-en-Roux gastric bypass surgery in obese elderly patients

Abstract Purpose To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique. Methods Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant. Results Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown. Conclusions Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.