Principales alimentos con azúcares añadidos y su variación geográfica y sociodemográfica: estudio latinoamericano de nutrición y salud (ELANS) / Main foods with added sugars and their geographic and sociodemographic variation: Latin American study of nutrition and health (ELANS)

Diversos estudios epidemiológicos y de intervención apuntan a una asociación fuerte y consistente entre la ingesta excesiva de azúcares y el riesgo de desarrollar caries dentales y enfermedades crónicas no transmisibles. El objetivo fue describir los 10 principales alimentos que contribuyen a la ingesta de azúcares añadidos en muestras representativas de poblaciones urbanas de ocho países latinoamericanos, y considerar diferencias por país, sexo, nivel socioeconómico (NSE) y grupo de edad. Se realizó una encuesta transversal multinacional en hogares de Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela (N=9218; 15­65 años). La contribución porcentual a la ingesta total del nutriente sirvió para identificar los alimentos aportadores. Los datos se estratificaron por país, sexo, NSE y grupo de edad y se compararon los gramos por día. Excepto en Perú y en el grupo de 50 a 65 años, los refrescos figuraron como el principal contribuyente a la ingesta de azúcares añadidos. Las bebidas caseras y las industrializadas también destacaron. Argentina fue el país con mayor ingesta de azúcares añadidos aportados por bebidas industrializadas, y Chile el país con menor frecuencia de bebidas como fuentes. Entre los 10 contribuyentes, la ingesta de azúcares añadidos fue mayor en el sexo masculino, excepto para sacarosa y pasteles dulces. Mayores ingestas de azúcares provenientes del jugo de fruta natural y sacarosa fueron observadas en el NSE más bajo. Las mayores y menores ingestas en los grupos de edad cambian de acuerdo con la fuente alimentaria. En conclusión, las bebidas azucaradas fueron los principales contribuyentes a la ingesta de azúcares añadidos, y la ingesta varió según la ubicación geográfica y los factores sociodemográficos(AU)

This study aimed to describe the top 10 foods that contribute to added sugars intake in representative samples of urban populations in eight Latin American countries, and consider differences by country, sex, socioeconomic level (SEL), and age group. A household-based, multinational, cross-sectional survey was conducted in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (N=9218; 15­65 years). Contributors to added sugars were identified and listed based on the percentage of contribution to total intake of this nutrient. Data were stratified by country, sex, SEL, and age group, and the grams per day compared. Except in Peru and in the 50 to 65 years age group, soft drinks were the leading contributor to added sugar intake. Homemade beverages together industrialized beverages have been a prominent position on ranking. In general, the highest intake of added sugars by industrialized beverages was from Argentina, and the lowest frequency of beverages as sources of added sugars was observed in Chile. Among the top 10 contributors, male sex had highest added sugar intake, except for sucrose and sweet cakes. Higher intakes of sugars from natural fruit juice and sucrose were observed in the lower SEL. The highest and lowest intakes in the age groups change according to the food source. In conclusion, sugar-sweetened beverages were main contributors to added sugar intake, and the intake vary with geographical location and sociodemographic factors(AU)

Impacto do consumo de alimentos ultraprocessados na saúde de crianças, adolescentes e adultos: revisão de escopo / Impacto del consumo de alimentos ultraprocesados en la salud de niños, adolescentes y adultos: revisión de alcances / Impact of the consumption of ultra-processed foods on children, adolescents and adults' health: scope review

O objetivo deste trabalho foi realizar uma revisão de escopo da literatura acerca da associação entre o consumo de alimentos ultraprocessados e desfechos em saúde. A busca foi realizada nas bases PubMed, Web of Science e LILACS. Foram elegíveis os estudos que avaliaram a associação entre o consumo de alimentos ultraprocessados identificados com base na classificação NOVA e os desfechos em saúde. O processo de revisão resultou na seleção de 63 estudos, os quais foram analisados em termos de qualidade com base em ferramenta do Instituto Nacional de Saúde dos Estados Unidos. Os desfechos encontrados incluíram indicadores de obesidade, marcadores de risco metabólico, diabetes, doenças cardiovasculares, câncer, asma, depressão, fragilidade, doenças gastrointestinais e mortalidade. A evidência foi particularmente consistente para obesidade (ou indicadores relacionados a ela) em adultos, cuja associação com o consumo de ultraprocessados foi demonstrada, com efeito dose-resposta, em estudos transversais com amostras representativas de cinco países, em quatro grandes estudos de coorte e em um ensaio clínico randomizado. Grandes estudos de coorte também encontraram associação significativa entre o consumo de alimentos ultraprocessados e o risco de doenças cardiovasculares, diabetes e câncer, mesmo após ajuste para obesidade. Dois estudos de coorte demonstraram associação do consumo de alimentos ultraprocessados com depressão e quatro estudos de coorte com mortalidade por todas as causas. Esta revisão sumarizou os resultados de trabalhos que descreveram a associação entre o consumo de alimentos ultraprocessados e as diversas doenças crônicas não transmissíveis e seus fatores de risco, o que traz importantes implicações para a saúde pública.

El objetivo de este estudio fue realizar una revisión de alcance de la literatura sobre la asociación entre el consumo de alimentos ultraprocesados y los resultados de salud. La búsqueda se realizó en las bases de datos PubMed, Web of Science y LILACS. Fueron elegibles los estudios que evaluaron la asociación entre el consumo de alimentos ultraprocesados identificados según la clasificación NOVA y los resultados de salud. El proceso de revisión resultó en la selección de 63 estudios, cuya calidad se analizó con base en una herramienta delo Instituto Nacional de Salud de Estados Unidos Los resultados encontrados incluyeron indicadores de obesidad, marcadores de riesgo metabólico, diabetes, enfermedad cardiovascular, cáncer, asma, depresión, fragilidad, enfermedad gastrointestinal y mortalidad. La evidencia fue particularmente consistente para la obesidad (o indicadores relacionados con ella) en adultos, cuya asociación con el consumo de alimentos ultraprocesados se demostró, con un efecto dosis-respuesta, en estudios transversales con muestras representativas de cinco países, en cuatro grandes estudios de cohortes y en un ensayo clínico aleatorizado. Grandes estudios de cohortes también encontraron una asociación significativa entre el consumo de alimentos ultraprocesados y el riesgo de enfermedades cardiovasculares, diabetes y cáncer, incluso después de ajustar la obesidad. Dos estudios de cohortes mostraron una asociación entre el consumo de alimentos ultraprocesados y la depresión y cuatro estudios de cohortes con mortalidad por todas las causas. Esta revisión resumió los resultados de estudios que describieron la asociación entre el consumo de alimentos ultraprocesados y las diversas enfermedades crónicas no transmisibles y sus factores de riesgo, lo que tiene importantes implicaciones para la salud pública.

The aim of this study was to conduct a literature scope review of the association between the consumption of ultra-processed foods and health outcomes. The search was carried out in the PubMed, Web of Science and LILACS databases. Studies that assessed the association between the consumption of ultra-processed foods, identified on the NOVA classification, and health outcomes were eligible. The review process resulted in the selection of 63 studies, which were analyzed in terms of quality using a tool from the National Institutes of Health. The outcomes found included obesity, metabolic risk markers, diabetes, cardiovascular diseases, cancer, asthma, depression, frailty, gastrointestinal diseases and mortality indicators. The evidence was particularly consistent for obesity (or indicators related to it) in adults, whose association with the consumption of ultra-processed foods was demonstrated, with dose-response effect, in cross-sectional studies with representative samples from five countries, in four large cohort studies and in a randomized clinical trial. Large cohort studies have also found a significant association between the consumption of ultra-processed foods and the risk of cardiovascular diseases, diabetes and cancer - even after adjusting for obesity. Two cohort studies have shown an association of ultra-processed foods consumption with depression and four cohort studies with all-cause mortality. This review summarized the studies' results that described the association between the consumption of ultra-processed foods and various non-communicable diseases and their risk factors, which has important implications for public health.

The role of health-related behaviors in gestational weight gain among women with overweight and obesity: A cross-sectional analysis / Papel dos comportamentos relacionados à saúde no ganho de peso gestacional em mulheres com sobrepeso e obesidade: Um estudo transversal

Abstract Objective To evaluate the influence of health-related behaviors including food intake, physical activity, sleep time, smoking habits, stress, depression, and optimism on excessive gestational weight gain (GWG) among women with overweight and obesity. Methods A cross-sectional study was conducted at the Women's Hospital of the Universidade de Campinas, Campinas, state of São Paulo, Brazil, with 386 mediate postpartum women that fit the inclusion criteria of ≥ 19 years old, first prenatal care visit at or before 14 weeks, and single live baby. Dietary habits, physical exercise practice, sleep duration, smoking and alcohol habits were self-reported. Psychosocial history was evaluated using the Edinburgh Postpartum Depression Scale (EPDS), Perceived Stress Scale (PSS), and Life Orientation Test-Revised (LOT-R). Sociodemographic, obstetric, anthropometric, and neonatal data were retrieved from medical records. Descriptive statistics and stepwise logistic regression were performed. Results The prevalence of overweight and obesity was 29.27% and 24.61%, respectively, according to the body mass index (BMI). Excessive GWG was observed in 47.79% of women with overweight and in 45.26% of women with obesity. Excessive GWG among overweight and obese women was associated with inadequate vegetable and bean consumption (odds ratio [OR] = 2.95, 95% confidence interval [CI]: 1.35-6.46 and OR = 1.91; 95%CI: 1.01-3.63, respectively) and stress (OR = 1.63; 95%CI 1.01-2.64). After adjustment by maternal age, multiparity, sleep duration, smoking, and alcohol intake, we found that stress (PSS ≥ 20) was associated with excessive GWG in women with overweight or obesity (OR: 1.75; 95%CI: 1.03-2.96). Conclusion Among women with overweight and obesity, stress is the main variable associated with excessive GWG. Inadequate vegetables and beans consumption also showed association with excessive GWG.

Resumo Objetivo Avaliar a influência de comportamentos relacionados à saúde: ingestão alimentar, atividade física, tempo de sono, tabagismo, estresse, depressão e otimismo no ganho de peso gestacional (GPG) excessivo em mulheres com sobrepeso e obesidade. Métodos Estudo transversal no Hospital da Mulher, Universidade de Campinas, Campinas, SP, Brasil, com 386 mulheres no puerpério mediato, ≥ 19 anos, primeira consulta pré-natal até 14 semanas e cuja gestação resultou em neonato vivo. Os comportamentos relacionados à saúde foram autorreferidos. História psicossocial foi avaliada usando: Escala de Depressão Pós-Parto de Edimburgo (EPDS, na sigla em inglês), Escala de Estresse Percebido (PSS, na sigla em inglês) e Teste de Orientação à Vida-Revisado (LOT-R, na sigla em inglês). Dados sociodemográficos, obstétricos, antropométricos e neonatais foram obtidos dos prontuários médicos. Realizou-se análises descritivas e regressão logística. Resultados A prevalência de sobrepeso e obesidade foi de 29,27% e de 24,61%, respectivamente. Ganho de peso gestacional excessivo foi observado em 47,79% das mulheres com sobrepeso e em 45,26% das mulheres com obesidade. O consumo inadequado de verduras e feijão (razão de probabilidade [OR] = 2,95; índice de confiança [IC] 95%: 1,35-6,46 e OR = 1,91; IC95%: 1,01-3,63, respectivamente) e estresse (OR = 1,63; IC95%: 1,01-2,64) foram associados ao GPG excessivo em mulheres com sobrepeso e obesidade. Análises ajustadas para idade materna, multiparidade, duração do sono, tabagismo e ingestão de álcool mostraram que o estresse (PSS ≥ 20) associou-se ao GPG excessivo em mulheres com sobrepeso e obesidade (OR = 1.75; 95%CI: 1.03-2.96). Conclusão Entre mulheres com sobrepeso e obesidade, o estresse foi a principal variável associada ao GPG excessivo. O consumo inadequado de verduras e feijão também se associou com o GPG excessivo.

Three-Dimensional Soft-Tissue Facial Morphometry in Caucasian Obese Adults

Objective: To evaluate the facial morphology of Caucasian obese adults in relation to normal weight peers, and to study the association between three-dimensional soft-tissue facial measurements and cardiometabolic risk factors. Material and Methods: Nineteen Caucasian obese subjects aged 25 to 73 years underwent anthropometric measurements, blood samples and a stereophotogrammetric facial scan. Soft-tissue facial linear distances, angles, and volumes were obtained and compared to those collected on normal weight subjects by computing z-scores. Spearman correlation was used to assess the associations between facial measurements and metabolic parameters. Logistic regression analysis adjusted for sex and age was used to assess the risk of metabolic syndrome associated to the facial measurements. Results: Overall, when compared to normal weight persons, obese adults had a wider face in the horizontal dimension, with a middle face (maxilla) that was larger both in absolute value and relatively to the lower face (mandible), and a larger right side gonial angle (Wilcoxon test, p < 0.01). Only the mean (left and right) gonial angle was positively associated to serum triglycerides level, while the other facial measurements were associated with none of the cardiometabolic parameters. Moreover, none of the facial measurements was associated with the risk of metabolic syndrome. Conclusion: Despite larger facial dimensions and altered mandible/maxilla volume ratio, three-dimensional soft-tissue facial morphometry in Caucasian obese adults is not related to cardiometabolic risk factors. The actual association between morphological facial characteristics and clinical information on the health conditions of patients is still to be investigated.

Fatores associados à obesidade em rodoviários da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil / Factors associated with obesity in urban collective transportation workers of the Metropolitan Region of Belo Horizonte, Minas Gerais, Brazil

RESUMO: Objetivo: Analisar os fatores demográficos, comportamentais e ocupacionais associados à obesidade em trabalhadores do transporte coletivo urbano de cidades da Região Metropolitana de Belo Horizonte (RMBH), Minas Gerais, Brasil. Método: Estudo transversal com 1.448 motoristas e cobradores da RMBH. Dados antropométricos, demográficos, comportamentais, de vínculo com a empresa e condições do ônibus foram coletados, em 2012, por meio de questionário aplicado face a face por entrevistador. Para o cálculo da obesidade, utilizou-se como ponto de corte o índice de massa corporal ≥ 30 kg/m2. Razões de prevalência (RP) e seus respectivos intervalos de confiança de 95% (IC95%) foram ajustados pela técnica de regressão multivariada de Poisson. Resultados: A prevalência da obesidade entre os trabalhadores foi de 16,1%. O sexo feminino (RP = 1,84; IC95% 1,37 - 2,49), estar nas faixas etárias dos 30 aos 39 anos (RP = 1,66; IC95% 1,17 - 2,37) e dos 40 aos 49 anos (RP = 1,59; IC95% 1,04 - 2,42), tempo no cargo de 5,01 a 10 anos (RP = 1,52; IC95% 1,04 - 2,42) e 20,01 a 47 anos (RP = 1,90; IC95% 1,21 - 3,00) e inatividade física (RP 1,32; IC95% 1,01 - 1,73) permaneceram independentemente associados à obesidade após o ajuste multivariado dos dados. Conclusão: Tais achados evidenciam a necessidade de considerar, nas discussões sobre promoção da saúde dos rodoviários, ações que incentivem a participação dos trabalhadores em atividades saudáveis, assim como a melhoria da organização e gestão do trabalho, para que este seja um promotor de saúde e bem-estar nesta população.

ABSTRACT: Objective: To analyze the demographic, behavioral and occupational factors associated with obesity among urban collective transportation workers of the Metropolitan Region of Belo Horizonte, Minas Gerais State, Brazil. Method: This is a cross-sectional study conducted with 1,448 drivers and collectors in the Metropolitan Region of Belo Horizonte. Anthropometric, demographic, behavioral data, as well as participants' link to the company and bus conditions were gathered in 2012 through a questionnaire applied by an interviewer. To calculate obesity, the body mass index cut off point was ≥ 30 kg/m2. Prevalence ratios (PR) and respective 95% confidence intervals (95%CI) were adjusted by Poisson's multivariate regression. Results: The prevalence of obesity among urban collective transportation workers was 16.1%. Female sex (PR = 1.84; 95%CI 1.37 - 2.49), aging 30 to 39 years old (PR = 1.66; 95%CI 1.17 - 2.37) and 40 to 49 years old (PR = 1.59; 95%CI 1.04 - 2.42), being in the same job role from 5.01 to 10 years (PR = 1.52; 95%CI 1.04 - 2,42) and from 20.01 to 47 years (PR = 1.90; 95%CI 1.21 - 3.00), and physical inactivity (PR = 1.32; 95%CI 1.01 - 1.73) remained independently associated with obesity after multivariate adjustment data. Conclusion: These findings highlight the need to consider actions that encourage employees to participate in healthy activities when discussing health promotion for public transport workers, as well as actions to improve the organization and management of work, so it becomes a health and well-being feature for this population.

Indice RECODE: aplicación y análisis en una población hospitalaria / Analysis and application of the RECODE Index in a hospital population

Las complicaciones crónicas de la diabetes mellitus pueden resultar en una baja calidad de vida, por lo cual la aplicación de un índice pronóstico puede ser una herramienta útil para mejorar esta situación.Objetivo: Asociar la presencia actual de complicaciones crónicas de la Diabetes Mellitus tipo 2, con las presentes 10 años antes aplicando la formula RECODE. Métodos: estudio observacional, analítico, longitudinal, retro-prospectivo en pacientes mayores de 30 años, se evaluaron las complicaciones crónicas en el presente y se aplicó la formula RECODE tomando los datos de la historia anterior. Tratamiento estadístico: estadística descriptiva para cada variable a través de análisis de frecuencia y porcentaje, además de la formula RECODE. Resultados: Se evaluaron 593 pacientes, con 308 exclusiones. El promedio de edad fue 63 años ± 15,5 DE. Hubo leve predominio de mujeres en 55%. En 75% de los pacientes había hipertensión. Las complicaciones crónicas encontradas fueron: nefropatía diabética 44%, neuropatía en 41% y afección cardiovascular en 14%. La mortalidad fue de 2%. Al confrontar las complicaciones crónicas que predice la formula RECODE en la actualidad, con los resultados de la fórmula con datos de 10 años previos, se encontró que todos los eventos ya estaban presentes durante la evaluación actual y la fórmula estimaba una menor frecuencia de los hallazgos documentados, con excepción de la cardiopatía isquémica o enfermedad cerebrovascular. Conclusión: La presencia de complicaciones crónicas actuales fue mayor a la que estimada según RECODE 10 años antes; aún así se concluye que dicha fórmula es útil para el cálculo de riesgo de complicaciones crónicas(AU)

The chronic complications of diabetes mellitus can result in a low quality of life for these patients. The application of a prognostic index can be a useful medical tool to improve this issue. Objective: To associate the present chronic complications of Type 2 Diabetes Mellitus, with the result of the application of the RECODE formula in the recent past. Methods: observational, analytical, longitudinal, retro-prospective study of patients older than 30 years. the chronic complications were assesed in the clinical record and at the present time using the RECODE formula as well as for the former 10 years Statistics:descriptive statistics for each variable through frequency and percentage analysis, in addition to the RECODE formula. Results: 593 patients were evaluated, with 308 exclusions. The average age was 63 years ± 15.5 SD. There was a slight predominance of women in 55%. Hypertension was present in 75%. Among the chronic complications found were: diabetic nephropathy 44%, followed by neuropathy in 41% and cardiovascular disease in 14%. Mortality was 2%. When comparing the present chronic complications predicted by the RECODE formula, with the results of the formula dated 10 years before we found that all the events were already present during the current evaluation and the formula estimated a lower frequency of the documented findings, with the exception of ischemic heart disease or cerebrovascular disease in 10 patients. Conclusion: The presence of current chronic complications was greater than estimated according to RECODE 10 years before.(AU)

Sarcopenia, obesity and sarcopenic obesity in liver transplantation: a body composition prospective study / Sarcopenia, obesidade e obesidade sarcopênica em pacientes submetidos ao transplante hepático: estudo prospectivo de composição corporal

ABSTRACT Background: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. Aim: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. Methods: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. Results: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. Conclusion: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.

RESUMO Racional: A sarcopenia é prevalente antes do transplante de fígado e é considerada fator de risco para morbidade/mortalidade desses pacientes. Após o transplante hepático, alguns autores sugerem que a sarcopenia permanece, e os pacientes ganham peso na forma de gordura, atingindo o status de obesidade sarcopênica. Objetivo: Avaliar prospectivamente as mudanças na composição corporal, prevalência e fatores associados em relação à sarcopenia, obesidade e obesidade sarcopênica após o transplante. Métodos: Os pacientes foram avaliados em dois momentos diferentes para composição corporal, 4,0±3,2 e 7,6±3,1 anos e após o transplante. Os dados da composição corporal foram obtidos por meio de bioimpedância elétrica. O índice de massa livre de gordura e o índice de massa gorda foram calculados, e os pacientes foram classificados nas seguintes categorias: sarcopênico; obesidade; obesidade sarcopênica. Resultados: Foram avaliados 100 pacientes (52,6±13,3 anos; 57,0% homens). A prevalência de sarcopenia (19,0% para 22,0%), obesidade (32,0% para 37,0%) e índice de massa livre de gordura (17,9±2,5 para 17,5±3,5 kg/m2), índice de massa gorda aumentou (8,5±3,5 para 9,0±4,0 kg/m2), e obesidade sarcopênica (0 para 2,0%) também aumentaram, embora não significativamente. O gênero feminino foi associado à sarcopenia. Conclusão: Após a operação, a gordura aumentou ao longo dos anos e a massa magra diminuiu, embora não significativamente. A sarcopenia e a obesidade estavam presentes após o transplante; no entanto, a obesidade sarcopênica não foi realidade observada nesses pacientes.

Relationship between minimally and ultra-processed food intake during pregnancy with obesity and gestational diabetes mellitus / A relação entre consumo de alimentos minimamente processados e ultraprocessados durante a gestação e obesidade e diabetes mellitus gestacional / La relación entre el consumo de comida mínimamente procesada y ultraprocesada durante embarazos con obesidad y diabetes mellitus gestacional

This study aimed to investigate the relationship between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight, obesity, and gestational diabetes mellitus conditions. This is a cross-sectional study conducted among 785 adult women in singleton pregnancies (between 24th and 39th weeks of gestation) in Brazil. Usual food intake was estimated by the Multiple Source Method, using two 24-hour dietary recalls. The food groups of interest in this study were the unprocessed or minimally processed foods and ultra-processed foods. The World Health Organization criteria for the diagnosis of gestational diabetes mellitus and the Atalah criteria for excess weight were used. Adjusted multinomial logistic regression models were used to assess the relationship between energy contribution (%E) from foods with overweight and obesity conditions and, adjusted logistic regression models for gestational diabetes mellitus. In total, 32.1% participants were overweight, 24.6% were obese, and 17.7% of women were diagnosed with gestational diabetes mellitus . After adjustments, an inverse association between the highest tertile of %E from the intake of unprocessed or minimally processed foods and obesity was found [0.49 (0.30-0.79)]. Moreover, a positive association between the highest tertile of %E from ultra-processed food intake [3.06 (1.27-3.37)] and obesity was observed. No association between food intake (considering the nature, extent, and purpose of food processing) during pregnancy and overweight or gestational diabetes mellitus was found. The findings suggest a role of food processing in obesity but not in gestational diabetes mellitus. Further research is warranted to provide robust evidence on the relationship between the role of processed foods in obesity and gestational diabetes mellitus.

O objetivo deste estudo foi investigar a relação entre o consumo de alimentos (considerando a natureza, extensão e propósito do processamento de alimentos) durante a gestação e sobrepeso, obesidade e diabetes mellitus gestacional. Estudo transversal realizado com 785 mulheres adultas com gestações únicas (24ª-39ª semanas de gestação) no Brasil. O consumo usual de alimentos foi estimado usando o Multiple Source Method, usando recordatórios alimentares de 24 horas. Os grupos alimentares de interesse neste estudo foram os alimentos não-processados e minimamente processados e os alimentos ultraprocessados. Os critérios da Organização Mundial da Saúde para diagnóstico de diabetes mellitus gestacional e critérios de Atalah para excesso de peso foram usados. Modelos de regressão logística multinomial foram empregados para avaliar a relação entre a contribuição energética (%E) de alimentos e sobrepeso e obesidade, e modelos de regressão logística ajustados foram usados para diabetes mellitus gestacional. No total, 32,1% das gestantes estavam com sobrepeso, 24,6% com obesidade e 17,7% foram diagnosticadas com diabetes mellitus gestacional. Após ajustes, uma associação inversa entre obesidade e o maior tercil de %E do consumo de alimentos não-processados ou minimamente processados foi encontrada [0,49 (0,30-0,79)]. Além disso, uma associação positiva entre obesidade e o maior tercil de %E do consumo de alimentos ultraprocessados [3,06 (1,27-3,37)] foi observada. Nenhuma associação entre consumo de alimentos (considerando a natureza, extensão e propósito do processamento de alimentos) durante a gestação e sobrepeso ou diabetes mellitus gestacional foi encontrada. Os resultados sugerem o papel do processamento de alimentos na obesidade, mas não na diabetes mellitus gestacional. Pesquisas adicionais são necessárias para fornecer evidências robustas sobre a relação entre o papel do processamento de alimentos na obesidade e na diabetes mellitus gestacional durante a gestação.

El objetivo del presente estudio fue investigar la relación entre el consumo de comida (considerando la naturaleza, alcance, y propósito del procesamiento de comida) durante el embarazo y el sobrepeso, obesidad, y diabetes mellitus gestacional. Se realizó un estudio transversal con 785 mujeres adultas de embarazos únicos (24ª-39ª semanas de gestación) en Brasil. El consumo habitual se estimó mediante un Multiple Source Method, usando dos encuestas de 24-hour en relación con los hábitos alimentarios. Los grupos de comidas de interés en el presente estudio fueron los mínimamente procesados o sin procesar y los productos de comida ultraprocesada. Se utilizaron criterios de la Organización Mundial de la Salud para el diagnostico de diabetes mellitus gestacional, y los criterios Atalah para el sobrepeso. Se utilizaron modelos ajustados de regresión logística multinomial para evaluar la relación entre la contribución energética (%E) de comidas con el sobrepeso y la obesidad, y modelos ajustados de regresión logística para la diabetes mellitus gestacional . En total, un 32,1% sufrían sobrepeso, un 24,6% eran obesas, y un 17,7% de las mujeres fueron diagnosticadas con diabetes mellitus gestacional. Tras los ajustes, se encontró una asociación inversa entre el tercil más alto de %E, procedente del consumo de comidas sin procesar o mínimamente procesadas con la obesidad [0,49 (0,30-0,79)]. Asimismo, se encontró una asociación positiva entre el tercil más alto de %E de comida ultraprocesada [3,06 (1,27-3,37)] y la obesidad. No se encontró ninguna asociación entre el consumo de comida (considerando la naturaleza, alcance, y propósito de la comida procesada) durante el embarazo y el sobrepeso, respecto a la diabetes mellitus gestacional. Los resultados sugieren la importancia de la comida procesada en la obesidad pero no así en la diabetes mellitus gestacional. Son necesarias más investigaciones para proporcionar evidencias sólidas sobre la relación entre el papel de la comida procesada en la obesidad y diabetes mellitus gestacional durante el embarazo.

Fatores ambientais associados à obesidade em população adulta de um município brasileiro de médio porte / Environmental factors associated with obesity in the adult population in a medium-sized Brazilian city / Factores ambientales asociados a la obesidad en una población adulta de un municipio brasileño de tamaño medio

Resumo: O objetivo deste trabalho foi estimar as associações entre as variáveis ambientais e a obesidade em população adulta de um município brasileiro de médio porte. Trata-se de estudo transversal com dados individuais de estudo de base populacional e dados ambientais obtidos por meio de observação direta, posteriormente georreferenciados com base nos endereços. A amostra incluiu 965 adultos de 20 a 59 anos. Utilizaram-se dados antropométricos, socioeconômicos, demográficos, comportamentais e de percepção de saúde. A variável desfecho foi a obesidade, definida por índice de massa corporal (IMC) ≥ 30kg/m2. Os estabelecimentos de venda de alimentos foram classificados em: supermercados, estabelecimentos com predominância de alimentos saudáveis, não saudáveis e mistos. O ambiente para a prática de atividade física foi categorizado em público e privado. Para a caracterização do ambiente social utilizou-se a renda per capita do setor censitário em terços e taxa de criminalidade. Realizou-se análise de regressão logística binária pelo modelo de equações de estimativa generalizadas. Foi verificada associação inversa entre a densidade dos locais públicos e privados para a prática de atividade física e obesidade (OR = 0,95, IC95%: 0,92-0,99; OR = 0,98, IC95%: 0,97-0,99), em modelos ajustados por variáveis individuais e ambientais. Em todos os modelos o terço de renda per capita mais alto associou-se inversamente à obesidade (p ≤ 0,05). O ambiente alimentar e as taxas de criminalidade não foram independentemente associados à obesidade. Tais achados sugerem que a renda do setor censitário e o ambiente de atividade física podem direcionar políticas públicas para a diminuição da obesidade no município.

Abstract: The aim of this study was to estimate associations between environmental variables and obesity in the adult population in a medium-sized Brazilian city. This was a cross-sectional study with individual data from a population-based study and environmental data obtained by direct observation, later georeferenced by the addresses. The sample included 965 adults 20 to 59 years of age, and the study used anthropometric, socioeconomic, demographic, behavioral, and self-rated health data. The outcome variable was obesity, defined as body mass index (BMI) ≥ 30kg/m2. Retail food outlets were classified as: supermarkets and establishments with a predominance of healthy, unhealthy, and mixed foods. Settings for physical activity were categorized as public and private. Characterization of the social environment used the census tracts' per capita income in tertiles and the crime rate. Binary logistic regression analysis was performed according to the generalized estimating equations model. An inverse association was found between density of public and private locations for physical activity and obesity (OR = 0.95, 95%CI: 0.92-0.99; OR = 0.98, 95%CI: 0.97-0.99) in models adjusted by individual and environmental variables. In all the models, the highest per capita income tertile was inversely associated with obesity (p ≤ 0.05). The food environment and crime rates were not independently associated with obesity. These findings suggest that the census tract's income and its environment for physical activity can orient public policies to decrease obesity in this city.

Resumen: El objetivo de este estudio fue estimar las asociaciones entre las variables ambientales y la obesidad en una población adulta de un municipio brasileño de tamaño medio. Se trata de un estudio transversal, con datos individuales de un estudio de base poblacional, y datos ambientales obtenidos mediante la observación directa, posteriormente georreferenciados a partir de las direcciones. La muestra incluyó a 965 adultos de 20 a 59 años. Se utilizaron datos antropométricos, socioeconómicos, demográficos, comportamentales y de percepción de salud. La variable desenlace fue la obesidad, definida por índice de masa corporal (IMC) ≥ 30kg/m2. Los establecimientos de venta de alimentos se clasificaron en: supermercados, establecimientos con predominio de alimentos saludables, no saludables y mixtos. El ambiente para la práctica de actividad física se categorizó en público y privado. Para la caracterización del ambiente social se utilizó la renta per capita del censo en terciles y la tasa de criminalidad. Se realizó un análisis de regresión logística binaria por el modelo de ecuaciones de estimación generalizadas. Se verificó la asociación inversa entre la densidad de los lugares públicos y privados para la práctica de actividad física y obesidad (OR = 0,95, IC95%: 0,92-0,99; OR = 0,98, IC95%: 0,97-0,99), en modelos ajustados por variables individuales y ambientales. En todos los modelos el tercio de renta per capita más alto se asoció inversamente a la obesidad (p ≤ 0,05). El ambiente alimentario y las tasas de criminalidad no estuvieron asociados independientemente a la obesidad. Tales resultados sugieren que la renta procedente del censo y el ambiente de actividad física pueden dirigir políticas públicas, con el fin de disminuir la obesidad en el municipio.

Utilidad del índice cintura/cadera en la detección del riesgo cardiometabólico en individuos sobrepesos y obesos / Usefulness of the waist/hip index in the detection of cardiometabolic risk in overweight and obese individuals

Introducción: el índice cintura/cadera se presenta como un elemento más de la valoración clínica de la obesidad y sus consecuencias. Objetivo: describir la utilidad del empleo del índice cintura/cadera en la detección del riesgo cardiometabólico. Métodos: se utilizó Google Académico como motor de búsqueda y se obtuvo un total de 97 artículos, de los cuales 61 fueron referenciados por cumplir con el objetivo enunciado. Resultados: la obesidad se comporta como una enfermedad multifactorial, de evolución crónica, con importantes consecuencias para la salud. El incremento del tejido adiposo abdominal, propicia una mayor síntesis y liberación de adipoquinas y otras sustancias, que pueden deteriorar el metabolismo lipídico y glucídico a través del aumento de la resistencia a la insulina, e incrementan el riesgo cardiovascular. El índice cintura/cadera evalúa de forma indirecta la grasa abdominal. Es un indicador poco costoso, sencillo de aplicar y fácil de interpretar en los 3 niveles de atención de salud de nuestro país. Se debe determinar su punto de corte para cada zona geográfica, ya que este puede variar de acuerdo con la entidad nosológica que estemos investigando y la muestra de pacientes estudiados, pues varía con el sexo y las características étnicas. Su empleo ayuda a predecir el riesgo cardiometabólico y de mortalidad en las personas estudiadas. Conclusiones: el índice cintura/cadera es útil en la predicción del riesgo cardiometabólico. Su correcto empleo mejoraría la calidad de los servicios en los 3 niveles de atención de salud en nuestro país(AU)

Introduction: waist/hip index is presented as another element of the clinical assessment of obesity and its consequences. Objective: to describe the usefulness of waist / hip index in the detection of cardiometabolic risk. Methods: Google Scholar was used as a search engine and a total of 97 articles were obtained, of which 61 were referenced for fulfilling the stated objective. Results: obesity behaves like a multifactorial disease of chronic evolution, with important consequences for health. The increase in abdominal adipose tissue promotes greater synthesis and release of adipokines and other substances, which can impair lipid and carbohydrate metabolism through increased insulin resistance, and increase cardiovascular risk. Waist/hip index evaluates abdominal fat indirectly. It is an inexpensive indicator, easy to apply and easy to interpret in the 3 levels of health care in our country. Its cut-off point must be determined for each geographical area, since this may vary according to the nosological entity we are investigating and the sample of patients studied, as it varies with sex and ethnic characteristics. Its use helps to predict cardiometabolic risk and mortality in the people studied. Conclusions: Waist/hip index is useful in the prediction of cardiometabolic risk. Its correct use would improve the quality of services in the 3 levels of health care in our country(AU)

Portadores de doença de Crohn apresentam maior acúmulo de gordura visceral: análise comparativa com controles saudáveis / Visceral fat is increased in individuals with crohn's disease: a comparative analysis with healthy controls

ABSTRACT BACKGROUND: It is known that obesity is associated with a chronic inflammatory state, but few studies have evaluated visceral fat (VF) content and its role in individuals with Crohn's disease (CD). OBJETIVE: To compare the nutritional status, body composition and proportion of VF between CD individuals and healthy volunteers. METHODS: Cross-sectional study that enrolled individuals with Crohn's disease and healthy controls. The stratification according to nutritional status was carried out by means of BMI. The percentage of body fat percentage (%BF) and VF were estimated by means of DEXA. VF proportion was evaluated by means of the VF/BMI and VF/%BF ratios. RESULTS: A total of 78 individuals were included. The control group was comprised of 28 healthy subjects aged 35.39±10 years old (60.7% women); mean BMI=23.94±3.34 kg/m2; mean VF=511.82±448.68 g; mean CRP=0.81±1.78 ng/mL. The CD group was comprised of 50 patients; 11 (22%) were underweight (BMI=18.20±1.97 kg/ m2; %BF=24.46±10.01; VF=217.18±218.95 g; CRP=4.12±4.84 ng/mL); 18 (36%) presented normal weight (BMI=22.43±1.48 kg/m2; %BF=30.92±6.63; VF=542.00±425.47 g and CRP=4.40±1.78 ng/mL); 21 (42%) were overweight or obese (BMI=29.48±3.78 kg/m2; %BF=39.91±7.33; VF=1525.23±672.7 g and CRP=1.33±2.06 ng/mL). The VF/BMI ratio was higher in the CD group when compared to controls (32.41±24.63 vs 20.01±16.23 g per BMI point; P=0.02). Likewise, the VF/%BF was also higher in the CD group (35.21±23.33 vs 15.60±12.55 g per percentage point; P<0.001). CONCLUSION: Among individuals with Crohn's disease, BMI presents a direct correlation with visceral fat content. These results indicate the presence of an adiposopathy in Crohn's disease subjects, which is evidenced by a higher visceral fat.

RESUMO CONTEXTO: Sabe-se que a obesidade associa-se a um estado de inflamação crônica, mas faltam estudos que avaliem o conteúdo de gordura visceral em indivíduos com doença de Crohn. OBJETIVO: Comparar o estado nutricional, a composição corporal e a proporção de gordura visceral entre indivíduos com doença de Crohn (DC) e controles saudáveis (CS). MÉTODOS: Estudo transversal com doença de Crohn e controles saudáveis. O estado nutricional foi estratificado de acordo com o índice de massa corpórea (IMC). O percentual de gordura corporal (%GC) e a mensuração da gordura visceral foram avaliados por DEXA. A proporção de gordura visceral (GV) foi avaliada pelas relações entre GV/IMC e GV/%GC. RESULTADOS: Foram incluídos 78 indivíduos no estudo. O grupo CS foi constituído por 28 indivíduos saudáveis, com idade média de 35,39±10 anos; 60,7% mulheres; IMC=23,94±3,34 kg/m2; %GC=32,7±7,89; GV=511,82±448,68 g e PCR=0,81±1,78 ng/mL. O grupo DC foi composto por 50 indivíduos, destes, 11 (22%) desnutridos (IMC=18,20±1,97 kg/m2; %GC 24,46±10,01; GV=217,18±218,95 g; PCR=4,12±4,84 ng/mL); 18 (36%) eutróficos (IMC=22,43±1,48 kg/m2; %GC=30,92±6,63; GV=542,00±425,47 g e PCR=4,40±1,78 ng/mL); 21 (42%); sobrepeso/obesidade (IMC=29,48±3,78 kg/m2; %GC=39,91±7,33; GV=1525,23±672,76 g e PCR=1,33±2,06 ng/mL). A relação GV/IMC foi maior no grupo DC quando comparado aos do grupo CS (32,41±24,63 vs 20,01±16,23 gramas por ponto do IMC; P=0,02), assim como a relação GV/%GC que também foi maior no grupo DC (23,33±33,33 vs 12,55±2,37 gramas por ponto percentual; P<0,001). CONCLUSÃO: Entre os indivíduos com doença de Crohn, o IMC apresentou correlação direta com o conteúdo de gordura visceral. Esses resultados sinalizam a ocorrência de adiposopatia nos pacientes com doença de Crohn, com maior volume de tecido adiposo visceral.

No cumplir con las recomendaciones de actividad física se asocia a mayores niveles de obesidad, diabetes, hipertensión y síndrome metabólico en población chilena / Association of physical inactivity with obesity, diabetes, hypertension and metabolic syndrome in the chilean population

Background: Physical inactivity is an important cardiovascular risk factor. Aim: To investigate the association of physical inactivity with obesity, metabolic markers, type 2 diabetes mellitus, hypertension and metabolic syndrome in Chilean adults. Material and Methods: Participants from the National Health Survey 2009-10 (n = 5,157) were included in this study. Body mass index, waist circumference, metabolic markers (blood glucose, glycosylated hemoglobin and lipid profile) were the outcomes. Type 2 diabetes, hypertension and metabolic syndrome were determined using international criteria. Physical activity levels were determined using the Global Physical Activity Questionnaire and physical inactivity was defined as < 600 METs/minutes/week. Results: Compared to their physically active peers, inactive men and women had a higher odds ratio (OR) for obesity (OR: 1.77 [95% confidence intervals (CI): 1.29-2.42], p < 0.01 and 1.25 [95% CI: 102-1.54], p < 0.035, respectively), diabetes (OR: 2.47 [1.80-3.38], p < 0.01 and 1.72 [1.35-2.19], p = 0.002, respectively) and hypertension (OR: 1.66 [1.31-2.09], p < 0.01 and 1.83 [1.54-2.18] respectively. An association of physical inactivity with central obesity and metabolic syndrome was observed only in men (OR: 1.92 [1.42- 2.58], p < 0.01 and 1.74 [1.23-2.47], p < 0.01, respectively). Conclusions: Not meeting the physical activity recommendations is associated with obesity, diabetes, hypertension and metabolic syndrome, which are important cardiovascular risk factors.

Socioeconomic status in childhood and obesity in adults: a population-based study / Posição socioeconômica na infância e obesidade em adultos: estudo de base populacional

ABSTRACT OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

RESUMO OBJETIVO Testar se há associação entre posição socioeconômica da infância e medidas de índice de massa corporal, circunferência da cintura e presença de obesidade geral e abdominal na vida adulta. MÉTODOS Análise transversal em estudo de coorte de base populacional, incluindo amostra de adultos (22-63 anos) residentes em Florianópolis, Sul do Brasil. A posição socioeconômica da infância foi analisada por meio da escolaridade dos pais e mães dos participantes. Estatura, peso e circunferência da cintura foram aferidos por entrevistadores previamente treinados. Foram empregadas regressões linear e logística com ajuste para fatores de confusão, e estratificação dos dados segundo sexo. RESULTADOS Dos 1.222 adultos avaliados, 20,4% (IC95% 18,1-22,8) apresentaram obesidade geral e 24,8% (IC95% 22,4-27,4), obesidade abdominal. As médias de índice de massa corporal e circunferência da cintura entre mulheres foram, respectivamente, 1,2 kg/m2 (IC95% -2,3- -0,04) e 2,8 cm (IC95% -5,3- -0,2) menores entre aquelas de maior posição socioeconômica na infância. Entre os homens, a circunferência da cintura foi 3,9 cm (IC95% 1,0-6,8) maior nos indivíduos de maior posição socioeconômica na infância. Em relação à obesidade, mulheres de maior posição socioeconômica na infância tiveram menores chances de obesidade abdominal (OR = 0,56; IC95% 0,34-0,90), não tendo sido observada tal associação entre os homens. CONCLUSÕES A posição socioeconômica na infância tem influência sobre índice de massa corporal, circunferência da cintura e obesidade em adultos, com diferença na direção da associação conforme o sexo. A maior posição socioeconômica entre os homens e a menor posição socioeconômica entre as mulheres estiveram associadas aos maiores indicadores de adiposidade.

Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs

Objective: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. Method: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. Results: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. Conclusion: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

Evaluación de tres metodologías para la predicción del riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad / Evaluation of three methodologies for risk prediction of impaired glucose metabolism in overweighed and obese subjects

Introducción: en la actualidad, en Cuba no existe una estrategia establecida para la pesquisa de las alteraciones del metabolismo de la glucosa. Objetivo: evaluar la capacidad diagnóstica de tres metodologías para predecir el riesgo de alteraciones del metabolismo de la glucosa en sujetos con sobrepeso y obesidad. Métodos: se realizó un estudio de evaluación diagnóstica longitudinal, con los datos de 90 sujetos con edades comprendidas entre 25 y 70 años, analizados 2,5 años después de la evaluación inicial. Se obtuvo la edad, el sexo, los antecedentes patológicos personales, los medicamentos empleados, el peso, la talla, el perímetro de cintura y la tensión arterial, así como las concentraciones de glucosa al inicio y a los 2,5 años ulteriores, la insulina y los triglicéridos, además de calcular la resistencia a la insulina en la evaluación inicial. Se utilizó un modelo de puntaje-riesgo para la diabetes tipo 2. Resultados: la frecuencia de alteraciones del metabolismo de la glucosa (glucemia alterada en ayuna y diabetes tipo 2) a los 2,5 años ulteriores, de acuerdo con la presencia previa o no en los sujetos de glucemia alterada en ayunas, resistencia a la insulina y riesgo moderado/alto de diabetes tipo 2, fue superior en los sujetos con glucemia alterada en ayuna previa (72,4 por ciento [21/29]), con resistencia a la insulina al inicio (65,6 por ciento [40/61]) y con riesgo moderado/alto (54,4 por ciento [43/79]), en relación con aquellos sin glucemia alterada en ayuna, sin resistencia a la insulina y con riesgo bajo de diabetes (41,0 por ciento [25/61], p= 0,005; 20,7 por ciento [6/29], p= 0,006 y 27,3 por ciento [3/11], p< 0,0001 respectivamente). La resistencia a la insulina y el riesgo de diabetes tipo 2 moderado/alto mostraron una elevada sensibilidad para identificar sujetos con alteraciones del metabolismo de la glucosa (87,0 y 93,5 por ciento respectivamente), por el contrario de la glucemia alterada en ayunas, que mostró una baja sensibilidad (45,7 por ciento). De los 19 sujetos que desarrollaron diabetes tipo 2 a los 2,5 años, el 100 por ciento presentó riesgo de diabetes tipo 2 moderado/alto y 94,7 por ciento resistencia a la insulina al inicio. Conclusiones: la resistencia a la insulina y el riesgo de diabetes tipo 2 podrían ser de gran utilidad en la identificación de individuos con alto riesgo para padecer diabetes(AU)

Introduction: at present, there is no set strategy in Cuba for the screening of impaired glucose metabolism. Objective: to evaluate the diagnostic capacity of three methodologies to predict the risk of impaired glucose metabolism in overweighed and obese individuals. Methods: a longitudinal diagnostic evaluation study was carried out using data from 90 subjects aged 25 to 70 years, which were analyzed two and a half years after the initial assessment. Information about age, sex, personal pathological history, used medication, weight, height, waist circumference and blood pressure as well the glucose concentrations at the beginning and two and a half years later, insulin and triglyceride indexes was collected in addition to estimating the insulin-resistance index in the initial evaluation. A risk-score model for type 2 diabetes was also used. Results: the frequency of impaired glucose metabolism (impaired fasting glycemia and type 2 diabetes) after two and a half years, according to the previous existence or not of impaired fasting glycemia, insulin resistance and moderate/high risk of type 2 diabetes, was higher in subjects with previous impaired fasting glycemia (72,4 percent [21/29]), with insulin resistance at the beginning (65.6 percent [40/61]) and with moderate/high risk (54,4 percent [43/79]) than in those individuals without impaired fasting glycemia, insulin resistance and with low diabetes risk (41.0 percent [25/61], p= 0,005; 20.7 percent [6/29], p= 0.006 and 27.3 percent [3/11], p< 0.0001, respectively). Insulin resistance index and moderate/high risk of type 2 diabetes showed high sensitivity to identify subjects with impaired glucose metabolism (87.0 and 93.5 percent, respectively), in contrast to impaired fasting glucose whose sensitivity was low (45.7 percent). Of 19 individuals who developed type 2 diabetes two and a half years later, 100 percent had moderate/high risk of type 2 diabetes and 94.7 percent had insulin resistance at the beginning. Conclusions: insulin resistance and risk of type 2 diabetes could be very useful in detecting individuals with high risk of developing diabetes(AU)

Mayores niveles de transporte activo se asocian a un menor nivel de adiposidad y menor riesgo de obesidad: resultados de la Encuesta Nacional de Salud 2009-2010 / Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010

Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p < 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p < 0.01]. The odds of having a BMI > 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes' increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p < 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults.

Relação entre consumo alimentar de vitaminas e minerais, índice de massa corporal e circunferência da cintura: um estudo de base populacional com adultos no Sul do Brasil / Relationship between dietary consumption of vitamins and minerals, body mass index, and waist circumference: a population-based study of adults in southern Brazil / Relación entre consumo alimentario de vitaminas y minerales, índice de masa corporal y circunferencia de la cintura: un estudio de base poblacional con adultos en el sur de Brasil

Resumo: O objetivo do estudo foi investigar a associação entre o consumo alimentar inadequado de micronutrientes e indicadores de obesidade geral e abdominal. Análise transversal, da segunda onda do estudo longitudinal EpiFloripa Adultos, incluindo 1.222 indivíduos de 22-63 anos, residentes em Florianópolis, Santa Catarina, Sul do Brasil. Os dados de consumo alimentar foram obtidos mediante aplicação de dois recordatórios de 24 horas, sendo o consumo habitual e as prevalências de inadequação no consumo de cálcio, ferro, zinco, e das vitaminas A, C, D e E estimadas conforme as recomendações do Instituto de Medicina e do Conselho Nacional de Pesquisa dos Estados Unidos. O estado nutricional de obesidade geral foi determinado considerando-se valores do índice de massa corporal (IMC), e a obesidade abdominal, considerando-se valores da circunferência da cintura (CC). Para a maioria dos micronutrientes investigados (cálcio, vitaminas A, C, D e E), as médias de consumo mostraram-se aquém dos valores recomendados, com prevalências elevadas de inadequação para toda a amostra. Somente a inadequação no consumo de vitamina C foi maior entre indivíduos obesos (geral ou abdominal). Além disso, associação inversa foi observada entre o menor consumo de cálcio e ferro com valores maiores do IMC e da CC, e entre o menor consumo das vitaminas A e D com valores maiores da CC (β = -0,92cm; IC95%: -1,76; -0,08 e β = -0,69cm; IC95%: -1,32; -0,06, respectivamente), principalmente entre adultos jovens. Foi possível identificar a existência de associação inversa entre o consumo alimentar inadequado de micronutrientes e o estado nutricional de obesidade geral e abdominal também em uma amostra de adultos residentes no Sul do Brasil.

Abstract: The study's objective was to investigate the association between inadequate dietary consumption of micronutrients and indicators of general and abdominal obesity. Cross-sectional analysis of the second wave of the EpiFloripa Adults longitudinal study, including 1,222 individuals, aged 22-63 years and residing in Florianópolis, Santa Catarina State, Southern Brazil. Food consumption data was obtained from two 24-hour food recalls, and habitual consumption and prevalence rates of inadequate consumption of calcium, iron, zinc, and vitamins A, C, D, and E were estimated according to the Institute of Medicine and National Research Council guidelines. General obesity was defined based on the body mass index (BMI) values and abdominal obesity was based on waist circumference (WC) values. For most of the micronutrients investigated (calcium and vitamins A, C, D, and E), consumption levels were below the recommendations, with high prevalence of inadequate consumption in the sample as a whole. Only inadequate vitamin C intake was higher among obese individuals (general or abdominal). In addition, there was an inverse association between lower consumption of calcium and iron and higher BMI and WC, and between lower consumption of vitamins A and D and higher WC levels (β = -0.92cm; 95%CI: -1.76; -0.08 and β = -0.69 cm; 95%CI: -1.32; -0.06, respectively), especially in young adults. The study showed an inverse association between inadequate dietary consumption of micronutrients and general and abdominal obesity in a sample of adults in Southern Brazil.

Resumen: El objetivo del estudio fue investigar la asociación entre el consumo alimentario inadecuado de micronutrientes e indicadores de obesidad general y abdominal. Métodos: análisis transversal, de la segunda fase del estudio longitudinal EpiFloripa Adultos, incluyendo 1.222 individuos de 22-63 años, residentes en Florianópolis, Santa Catarina, Sur de Brasil. Los datos de consumo alimentario fueron obtenidos mediante aplicación de dos recordatorios de 24 horas, siendo estimados, conforme las recomendaciones del Instituto de Medicina y del Consejo Nacional de Investigación, de los EEUU. El estado nutricional de obesidad general fue determinado considerándose valores del índice de masa corporal (IMC), y la obesidad abdominal, considerándose valores de la circunferencia de la cintura (CC). Para la mayoría de los micronutrientes investigados (calcio, vitaminas A, C, D y E), las medias de consumo fueron menores que las recomendaciones, con prevalencias elevadas de inadecuación para toda la muestra. Solamente la inadecuación en el consumo de vitamina C fue mayor entre individuos obesos (general o abdominal). Además, asociación inversa fue observada entre el menor consumo de calcio e hierro con valores mayores de IMC y de la CC, y entre el menor consumo de vitaminas A y D con valores mayores de la CC (β = -0,92cm; IC95%: -1,76; -0,08 y β = -0,69cm; IC95%: -1,32; -0,06), principalmente entre adultos jóvenes. Fue posible identificar la existencia de asociación inversa entre el consumo alimentario inadecuado de micronutrientes y el estado nutricional de obesidad general y abdominal en una muestra de adultos residentes en el Sur de Brasil.

Medición de la ingestión de sodio en la dieta de un grupo de niños entre uno y 18 meses de edad en una consulta pediátrica en Cali, Colombia / Measurement of dietary sodium intake in a group of children from one to 18 months of age in a pediatric service in Cali, Colombia

Resumen Introducción. Las estrías de grasa en la pared arterial pueden aparecer desde el tercer año Resumende vida y se relacionan con factores de riesgo aterogénico, como la hipertensión arterial sistémica y el contenido de sodio en la dieta. En pocos estudios se reporta el consumo de sodio en la dieta debido a la dificultad para la recolección de los datos. Objetivo. Determinar el consumo promedio de sodio en la dieta de niños de uno a 18 meses de edad, mediante una encuesta sobre la dieta a lo largo de tres días. Materiales y métodos. Se hizo un estudio de corte transversal con 48 niños sin enfermedad renal ni restricciones en la dieta, atendidos en consulta pediátrica entre enero y junio del 2011, el cual incluyó una encuesta sobre la dieta a los padres y la clasificación del estado nutricional por antropometría y medición de la presión arterial. Se analizaron el contenido de sodio y demás nutrientes de la dieta con el Programa Internacional de Consumo de Alimentos (CERES), las medidas antropométricas con el programa Anthro de la Organización Mundial de la Salud y las características sociodemográficas con el programa de Epi-info. Resultados. El 69 % de los niños tenía un consumo alto de sodio, el 6,2 % presentaba presión arterial elevada, y el 20,7 %, sobrepeso y obesidad. Conclusiones. La prevalencia de hipertensión arterial sistémica superó la informada para Colombia (1 a 3 %). Dos de los tres niños con presión arterial elevada tenían una dieta rica en sodio, así como sobrepeso y obesidad con valores superiores a lo informado para Colombia (16 %). Se sugiere medir la presión arterial tempranamente, recomendar la restricción de sal y azúcar en la alimentación de los menores de dos años, desarrollar estudios más grandes para obtener datos poblacionales sobre la ingestión de sodio, y diseñar estrategias de intervención, adecuadas y oportunas, para disminuir los riesgos en la edad adulta.

Abstract Introduction: The fatty streaks in an arterial wall can appear from the third year of age, and they show an association with atherogenic risk factors such as hypertension and sodium in the diet. Given the difficulty of data gathering, few studies report the intake of sodium in the diet. Objective: To determine average sodium intake in the diet of children between one and 18 months of age through a three-day dietary survey. Materials and methods: This was a cross-sectional study with 48 children without renal disease or diet restrictions seen in pediatric practice between January and June, 2011. It included a dietary survey for the parents, nutritional status classification by anthropometry, and blood pressure measurements. Sodium content and other nutrients in the diet program were analyzed with the International Food Consumption Program (CERES), anthropometry with the World Health Organization Anthro program, and Epi-info for socio-demographic characteristics. Results: In total, 69% of children had high sodium consumption, 6.2% had high blood pressure, and 20.7% were overweight and obese. Conclusions: The prevalence of hypertension exceeds that reported for Colombia (1-3%). Two of the three children with high blood pressure had high sodium intake and they were overweight and obese, with values above those reported for Colombian children (16%). We suggest to measure blood pressure early, and to restrict salt and sugar in food for infants and children under two years of age. Also, larger studies should be conducted to collect population data on sodium intake and develop appropriate and timely intervention strategies to reduce risks in adulthood.

Índice, carga glicémica y fibra dietética de los alimentos y su asociación con resistencia a la insulina en adultos chilenos / Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults

El Índice y Carga Glicémica (IG y CG) categorizan los alimentos según su capacidad de incrementar la glicemia, considerando cantidad y calidad de hidratos de carbono consumidos. Diferentes estudios han postulado que una dieta con IG y CG altos y bajo consumo de fibra incrementan la glicemia e insulinemia, aunque con resultados heterogéneos.El objetivo de este estudio fue analizar la asociación entre IG, CG e ingesta de fibra y valores HOMA-IR en adultos jóvenes. En una muestra representativa de 738 personas que tenían entre 32 y 38 años, nacidos en el Hospital de Limache, Región de Valparaíso, Chile, se recogió información socioeconómica, de salud, se determinó estado nutricional, glicemia, insulina basal y HOMA, y con la encuesta de frecuencia de consumo se estimó IG, CG e ingesta de fibra. Se construyeron modelos de regresión múltiple, controlando efectos de confusión e interacción. En modelos ajustados, se observó que por cada 10 unidades que aumenta el IG y CG de la dieta en individuos con exceso de peso, aumenta el HOMA-IR en 0,31 (p=0,042) y 0,03 (p=0,012), respectivamente y por cada 10 gramos que aumenta la fibra total y soluble, disminuye el HOMA-IR en 0,10 (p=0,04) y 0,62 (p=0,034) respectivamente. En personas sin exceso de peso no hubo estos efectos. Existe una asociación directa entre el aumento de IG y CG de los alimentos y el incremento de HOMA-IR sólo en individuos con exceso de peso y una asociación inversa entre ingesta de fibra dietética total y soluble y HOMA-IR(AU)

Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults. Glycemic index and glycemic load (GI and GL) categorize foods according to their ability to increase blood sugar levels, considering quantity and quality of carbohydrates consumed. Different studies have postulated that a high GI and GL diet and low fiber intake increased glycemia and insulinemia, although with heterogeneous results. The aim of this study was to analyze the association between GI, GL and fiber intake and HOMA-IR values in young adults. In a representative sample of 738 people aged between 32 and 38 years old, born in the Limache's Hospital, Valparaiso, Chile, socioeconomic and health information, nutritional status, basal glycemia, insulin and HOMA were collected. With a food frequency questionnaire, GI, GL and fiber intake were estimated. Multiple regression models were constructed, controlling confounding and interaction effects. In adjusted models, it was found that for every 10 units that increases diet GI and GL in overweight individuals, HOMA- IR increases in 0.31 (p = 0.042) and 0.03 (p = 0.012) respectively, and for every 10 grams that increases total and soluble fiber intake, HOMA-IR reduces in 0.10 (p = 0.04) and 0.62 (p = 0.034) respectively. In people without overweight such effects were not observed. There was a direct association bet- ween increased GI and GL foods and increased HOMA-IR only in individuals with overweight and an inverse association between total and soluble fiber intake and HOMA-IR(AU)