Effect Modification of Cardiorespiratory Fitness, Obesity, and Physical Activity in Adults.

We investigated if cardiorespiratory fitness modifies the association between obesity and the level of physical activity. In this cross-sectional study, we analyzed data from 746 adults, free of diagnosed cardiorespiratory or locomotor diseases. We analyzed sociodemographic and clinical information, cardiovascular risk factors, cardiorespiratory fitness, anthropometry, and level of physical activity (time spent in moderate-to-vigorous physical activity). Those that spent more time in moderate-to-vigorous physical activity were younger, male, with lower body mass index, without self-reported arterial blood hypertension, diabetes and dyslipidemia, non-smokers, and presented with better cardiorespiratory fitness. The linear regression coefficients showed that cardiorespiratory fitness changes according to the level of physical activity and body mass index (obesity in low cardiorespiratory fitness: ß 6.0, p=0.213, 95%CI-3.5 to 15.6; in intermediate cardiorespiratory fitness: ß 6.3, p=0.114, 95%CI-1.5 to 14.2; in high cardiorespiratory fitness: ß-6.3, p=0.304, 95%CI-18.4 to 5.8). This effect modification trend was present after adjusting the model by covariates. Cardiorespiratory fitness potentially modifies the association between body mass index and the level of physical activity. It should be routinely assessed to identify persons with overweight/ obesity with low/ intermediate cardiorespiratory fitness to prescribe individualized training.

Adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers as prognostic factors of early-stage large-cell neuroendocrine carcinoma.

BACKGROUND: We investigated whether adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers affected survival of patients with the early stage of large-cell neuroendocrine cancer. METHODS: This was a retrospective multicenter study including consecutive patients undergoing resection of node negative large-cell neuroendocrine carcinoma. Five-year survival and disease-free survival rate were evaluated by the Kaplan-Meier method and the log-rank test in relation to adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers (synaptophysin, chromogranin A, and neuron-specific enolase). RESULTS: Our study population included 117 patients; 47 (40%) of these received adjuvant chemotherapy. Patients treated with adjuvant chemotherapy had better survival (74% vs. 45%, p = 0.002) and disease-free survival (79% vs. 40%, p = 0.001) in all cases except patients with tumor <20 mm (79.5% vs. 57.4%, p = 0.43). Lobectomy compared to sublobar resection was associated with better survival (67% vs. 0.1%, p < 0.0001) and disease-free survival (65% vs. 0.1%, p < 0.0001) also in patients with tumor <20 mm (79% vs. 28%, p = 0.001). Patients with triple-positive neuroendocrine markers had better survival (79% vs. 35%, p = 0.0001) and disease-free survival (69% vs. 42%, p = 0.0008). Regression analysis showed that tumor size <20 mm, lobectomy, adjuvant chemotherapy, and triple-positive immunistochemical neuroendocrine markers were significant favorable prognostic factors for survival outcomes. CONCLUSIONS: Lobectomy seems to be the management of choice in patients with large-cell neuroendocrine cancer <20 mm while adjuvant chemotherapy should be administered only in patients with tumor >20 mm.

Dipeptidyl Peptidase IV Inhibitors for Nonalcoholic Fatty Liver Disease - Systematic Review and Metanalysis.

INTRODUCTION: Hepatic steatosis is a frequent condition that afflicts, especially, obese and insulin-resistant patients. Diagnosis is usually made through imaging tests. Despite the high prevalence and risk of complications, there is no specific treatment approved, though a vast number of medications have been tested. OBJECTIVE: This study aimed to determine the efficacy of dipeptidyl peptidase IV inhibitors (i DPP- IV) in the treatment of NAFLD. METHODS: We searched the electronic databases of the Cochrane Library, MEDLINE, EMBASE, and LILACS, as well as reference lists of the included studies and grey literature; 9 studies were selected for inclusion. RESULTS: 7 studies were used for metanalysis for 3 outcomes. i DPP-IV showed an ALT-reducing power of MD -10.83 (95% CI 35.23 to 13.57) at 3 months and MD -9.27 (95% CI 10.92 to -7.62) at 6 months of intervention, as well as a reduction of hepatic steatosis via MRI of SMD 0.10 (95% CI 0.31 to 0.50); the overall incidence of adverse events was very low. The studies were considered of low and very low quality by the GRADE evaluation. CONCLUSION: Because of the overall poor quality of the studies and heterogeneity of the population analyzed, i DPP-IV did not show efficacy on inflammatory markers or fibrosis in patients with NAFLD.

Dynamic physiological responses in obese and non-obese adults submitted to cardiopulmonary exercise test.

PURPOSE: Obese individuals have reduced performance in cardiopulmonary exercise testing (CPET), mainly considering peak values of variables such as oxygen uptake ([Formula: see text]), carbon dioxide production ([Formula: see text]), tidal volume (Vt), minute ventilation ([Formula: see text]) and heart rate (HR). The CPET interpretation and prognostic value can be improved through submaximal ratios analysis of key variables like [Formula: see text], [Formula: see text], [Formula: see text] [Formula: see text] and oxygen uptake efficiency slope (OUES). The obesity influence on these responses has not yet been investigated. Our purpose was to evaluate the influence of adulthood obesity on maximal and submaximal physiological responses during CPET, emphasizing the analysis of submaximal dynamic variables. METHODS: We analyzed 1,594 CPETs of adults (755 obese participants, Body Mass Index ≥ 30 kg/m2) and compared the obtained variables among non-obese (normal weight and overweight) and obese groups (obesity classes I, II and III) through multivariate covariance analyses. RESULT: Obesity influenced the majority of evaluated maximal and submaximal responses with worsened CPET performance. Cardiovascular, metabolic and gas exchange variables were the most influenced by obesity. Other maximal and submaximal responses were altered only in morbidly obese. Only a few cardiovascular and ventilatory variables presented inconsistent results. Additionally, Vtmax, [Formula: see text], Vt/Inspiratory Capacity, Vt/Forced Vital Capacity, Lowest [Formula: see text], [Formula: see text], and the y-intercepts of [Formula: see text] did not significantly differ regardless of obesity. CONCLUSION: Obesity expressively influences the majority of CPET variables. However, the prognostic values of the main ventilatory efficiency responses remain unchanged. These dynamic responses are not dependent on maximum effort and may be useful in detecting incipient ventilatory disorder. Our results present great practical applicability in identifying exercise limitation, regardless of overweight and obesity.

Subxifoid versus transthoracic thoracoscopic lobectomy: Results of a retrospective analysis before and after matching analysis.

BACKGROUND: Here, we report our initial experience with subxifoid video-assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness. METHODS: The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one- month, and three months after surgery). The two groups were compared before and after matching analysis. RESULTS: Our study population included 223 patients: 84 in the SVATS and 139 in the CVATS group. The two groups were not comparable for sex (P = 0.001), preoperative comorbidity as cardiopathy (P = 0.007), BMI value (P = 0.003), left-sided procedure (P = 0.04), tumor stage (P = 0.04), and tumor size (P = 0.002). These differences were overcome by propensity score matching (PSM) analysis that yielded two well-matched groups which included 61 patients in each group. Surgical outcomes including blood loss, hospital stay and complications were similar before and after matching analysis, but SVATS compared to CVATS was associated with longer operative time before (159 ± 13 vs. 126 ± 6.3, P < 0.0001), and after matching analysis (161 ± 23 vs. 119 ± 8.3; P < 0.0001) and significant reduction of postoperative pain during the different time-points (P < 0.001), and paresthesia at one (P = 0.001), and three months (P < 0.0001). CONCLUSIONS: SVATS lobectomy is a feasible and safe strategy with surgical outcomes similar to CVATS lobectomy but with less postoperative pain and paresthesia. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Subxifoid thoracoscopic lobectomy is a feasible and safe procedure, with potential benefits in terms of postoperative pain and paresthesia compared to conventional thoracoscopic lobectomy Our results showed that surgical outcomes including blood loss, hospital stay, morbidity and mortality are similar but subxifoid thoracoscopy was associated with significant reduction of postoperative pain and paresthesia. WHAT THIS STUDY ADDS: Subxifoid thoracoscopy is a safe procedure; compared to conventional transthoracic thoracoscopy, it avoids intercostal incisions, and spares nerve trauma, resulting in a reduction of postoperative pain and paresthesia.

Effects of the juçara fruit supplementation on metabolic parameters in individuals with obesity: a double-blind randomized controlled trial.

Adipose tissue inflammation has been proposed as a central mechanism connecting obesity with its metabolic and vascular complications due to the imbalance in the expression of several hormones and adipokines. Berries rich in polyphenols and unsaturated fatty acids have been able to prevent both obesity and adipose tissue inflammation, improving metabolic functions in human subjects and animal models of obesity. Juçara has been considered a super fruit owing to its nutritional composition and relevant biological activities with an interesting response in animals. Thus, we aimed to verify the potential antiobesogenic effect of juçara supplementation in humans. We conducted a double-blind, placebo-controlled, randomized trial with 35 adults with obesity of both sexes. They were assessed for resting metabolic rate, anthropometry and body composition, blood pressure, metabolic parameters and adipokines. Subsequently, they were randomized into two groups to use or not (placebo) 5 g lyophilized juçara for 6 weeks. Supplementation with juçara was significantly effective in reducing body fat, increasing high-density lipoprotein cholesterol and doubling serum adiponectin. Besides, juçara supplementation, high-density lipoprotein cholesterol and neck circumference were predictors to explain the enhancement in adiponectin. Juçara supplementation was determinant to improve adiponectin levels, and it may be considered a novel strategy for the treatment of obesity-related metabolic diseases.

Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART).

BACKGROUND: The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. OBJECTIVE: We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants' perception regarding the protocol and the use of the app for physical activity qualitatively. METHODS: We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. RESULTS: Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median -198 steps/day [IQR -279 to -103] to 20 steps/day [IQR -204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants' reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. CONCLUSIONS: The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.

Dose-response relationship between very vigorous physical activity and cardiovascular health assessed by heart rate variability in adults: Cross-sectional results from the EPIMOV study.

The minimum amount of physical activity needed to obtain health benefits has been widely determined. Unlikely, the impact of extreme amounts of very vigorous physical activity (VVPA, ≥ 8 metabolic equivalents) to the heart remains controversial. We aimed to evaluate the dose-response relationship between VVPA and heart rate variability (HRV) in adults. We selected 1040 asymptomatic individuals (60% women, 42 ± 15 years, 28 ± 6 kg/m2) from the Epidemiology and Human Movement Study (EPIMOV). Participants remained in the supine position for 10 min, and we selected an intermediate 5-min window for HRV analysis. The standard deviation of the RR intervals, root mean square of RR intervals, successive RR intervals that differ > 50 ms, powers of the low-and high-frequency bands and Poincaré plot standard deviations were quantified. Participants used a triaxial accelerometer (Actigraph GT3x+) above the dominant hip for 4-7 consecutive days for quantifying their physical activity. We also evaluated the maximum oxygen uptake ([Formula: see text]) during an exercise test. We stratified participants into five groups according to the VVPA in min/week (group 1, ≤ 1.50; 2, 1.51-3.16; 3, 3.17-3.54; 4, 3.55-20.75; and 5, > 20.75). The linear trends of the HRV through the quintiles of VVPA were investigated. We used logarithmic transformations to compare the five groups adjusted for age, sex, cardiovascular risk, and [Formula: see text]. We found a better HRV with increased VVPA for all HRV indices studied (p trend < 0.05). However, group 5 did not differ from group 4 (p > 0.05) for none of the indices. We conclude that there is an incremental benefit of VVPA on HRV of asymptomatic adults. Since we found neither additional benefits nor the harmful impact of amounts of VVPA as high as 22 min/week on HRV, our results should not discourage asymptomatic adults to perform VVPA.

Impact of metabolic syndrome on the outcome of patients with stable coronary artery disease: 2-year follow-up of the MASS II study.

OBJECTIVE: We characterized the impact of the metabolic syndrome (MetS) and its components on cardiovascular adverse events in patients with symptomatic chronic multivessel coronary artery disease, which have been followed prospectively for 2 years. METHODS: Patients enrolled in the MASS II study were evaluated for each component of the MetS, as well as the full syndrome. RESULTS: The criteria for MetS were fulfilled in 52% of patients. The presence of MetS (P<0.05), glucose intolerance (P=0.007), and diabetes (P=0.04) was associated with an increased mortality in our studied population. Moreover, despite a clear tendency for each of its components to increase the mortality risk, only the presence of the MetS significantly increased the risk of mortality among nondiabetic study participants in a multivariate model (P=0.03, relative risk 3.5, 95% confidence interval 1.1-6). Finally, MetS was still associated with increased mortality even after adjustment for diabetes status. These results indicate a strong and consistent relationship of the MetS with mortality in patients with stable coronary artery disease. CONCLUSION: Although glucose homeostasis seems to be the major force driving the increased risk of MetS, the operational diagnosis of MetS still has information for stratifying patients when diabetes information is taken into account.

A new equation to predict peak VO2 in obese patients during cardiopulmonary exercise testing.

We aimed to develop an equation to predict peak VO2 in obese subjects undergoing CPET. In addition, we evaluated and compared three published equations. We randomized 346 obese subjects undergoing CPET into a group for developing the equation (n = 272) and a group for cross-validation (n = 74), compared through the Bland and Altman method. Height, sex and age were responsible for 85·5% of total variability of the peak VO2. Additional 1% and 0·7% of the variability were, respectively, explained by physical inactivity and diabetes. The equation devised was as follows: peakVO2mlmin-1=-677·8+(2135·9×heightm)+(706·8×sexmales=1;females=0)-(15·5×ageyears)-(161·1×physicalinactivityyes=1;no=0)-(176·3×diabetesyes=1;no=0). The mean difference between the estimated and measured peak VO2 was 7 ml min-1 , with a 23·9% bias. Published equations overestimated the peak VO2 by 35·3%, 49·1% and 46·2% bias. The equation developed in this study performed better in predicting peak VO2 in obese adults improving ramp protocol design and CRF evaluations in obese subjects.

Evaluation of waist-to-height ratio as a predictor of insulin resistance in non-diabetic obese individuals. A cross-sectional study.

BACKGROUND: Insulin resistance (IR) and progressive pancreatic ß-cell dysfunction have been identified as the two fundamental features in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus. We aimed to investigate correlations between anthropometric indices of obesity and IR in non-diabetic obese individuals, and the cutoff value from receiver operating characteristic (ROC) curve analysis. DESIGN AND SETTING: Cross-sectional study conducted in a private clinic. METHODS: We included obese individuals (body mass index, BMI ≥ 30 kg/m2) with no diabetes mellitus (fasting glucose levels ≤ 126 mg/dl). The participants were evaluated for the presence of cardiovascular risk factors and through anthropometric measurements and biochemical tests. Furthermore, IR was assessed indirectly using the homeostatic model assessment (HOMA)-IR and HOMA-ß indexes. The area underthe curve (AUC) of the variables was compared.The sensitivity, specificity and cutoff of each variable for diagnosing IR were calculated. RESULTS: The most promising anthropometric parameters for indicating IR in non-diabetic obese individuals were waist-to-height ratio (WHtR), waist circumference (WC) and BMI. WHtR proved to be an independent predictor of IR, with risk increased by 0.53% in HOMA-IR, 5.3% in HOMA-ß and 1.14% in insulin. For HOMA-IR, WHtR had the highest AUC value (0.98), followed by WC (0.93) and BMI (0.81). For HOMA-ß, WHtR also had the highest AUC value (0.83), followed by WC (0.75) and BMI (0.73).The optimal WHtR cutoff was 0.65 for HOMA-IR and 0.67 for HOMA-ß. CONCLUSION: Among anthropometric obesity indicators, WHtR was most closely associated with occurrences of IR and predicted the onset of diabetes in obese individuals.

Living near the port area is associated with physical inactivity and sedentary behavior.

CONTEXT AND OBJECTIVE:: The impact of the port of Santos, Brazil, on the population's health is unknown. We aimed to evaluate the association between living near the port area and physical inactivity and sedentary behavior. DESIGN AND SETTING:: Cross-sectional study developed at a university laboratory and a diagnostic clinic. METHODS:: 553 healthy adults were selected and their level of physical activity in daily life was assessed using accelerometers. Multiple linear and logistic regressions were performed using physical inactivity and sedentary behavior as the outcomes and living near the port area as the main risk factor, with adjustments for the main confounders. RESULTS:: Among all the participants, 15% were resident near the port area. They took 699 steps/day and presented, weekly, 2.4% more sedentary physical activity, 2.0% less time in standing position and 0.9% more time lying down than residents of other regions. Additionally, living near the port area increased the risk of physical inactivity by 2.50 times and the risk of higher amounts of sedentary behavior (≥ 10 hours/day) by 1.32 times. CONCLUSION:: Living near the port of Santos is associated with physical inactivity and higher sedentary behavior among adults, regardless of confounders. The reasons for this association should be investigated in longitudinal studies.

Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults.

OBJECTIVE: To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL), as well as with cardiovascular disease (CVD) risk factors, in asymptomatic adults. METHODS: A total of 374 participants (mean age, 41 ± 14 years) underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. RESULTS: A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness), the following variables retained significance (OR; 95% CI) as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8), smoking (11.6; 1.56-87.5), physical inactivity (8.1; 1.43-46.4), larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71); and dyslipidemia (1.89; 1.12-1.98). CONCLUSIONS: A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.

Association between physical activity in daily life and pulmonary function in adult smokers.

OBJECTIVE: To determine whether the level of physical activity in daily life (PADL) is associated with pulmonary function in adult smokers. METHODS: We selected 62 adult smokers from among the participants of an epidemiological study conducted in the city of Santos, Brazil. The subjects underwent forced spirometry for pulmonary function assessment. The level of PADL was assessed by the International Physical Activity Questionnaire and triaxial accelerometry, the device being used for seven days. The minimum level of PADL, in terms of quantity and intensity, was defined as 150 min/week of moderate to vigorous physical activity. Correlations between the studied variables were tested with Pearson's or Spearman's correlation coefficient, depending on the distribution of the variables. We used linear multiple regression in order to analyze the influence of PADL on the spirometric variables. The level of significance was set at 5%. RESULTS: Evaluating all predictors, corrected for confounding factors, and using pulmonary function data as outcome variables, we found no significant associations between physical inactivity, as determined by accelerometry, and spirometric indices. The values for FVC were lower among the participants with arterial hypertension, and FEV1/FVC ratios were lower among those with diabetes mellitus. Obese participants and those with dyslipidemia presented with lower values for FVC and FEV1. CONCLUSIONS: Our results suggest that there is no consistent association between physical inactivity and pulmonary function in adult smokers. Smoking history should be given special attention in COPD prevention strategies, as should cardiovascular and metabolic comorbidities.

Association between obesity and sedentary behavior in adults / Associação entre a obesidade e o comportamento sedentário em adultos

Abstract Although sedentary behavior (SB) is related to the development of metabolic diseases, there is still no consensus in literature about the association between accelerometer-based SB and obesity, especially adjusted for cardiovascular risk factors and level of daily physical activities. The aim was to evaluate the association between obesity and SB adjusted for potential confounders in adults. Data from 780 participants of the Epidemiology and Human Movement (EPIMOV) Study were analyzed. Body weight, body mass index (BMI), and fat body mass as percentage (%FBM) (bioelectrical impedance) were obtained and, then, used to stratify participants. SB was objectively measured using triaxial waist-worn accelerometers placed above the dominant hip during waking hours for at least four consecutive days (4-7 days). SB and its pattern were not significantly different between obesity groups. Although SB presented some significant correlations with obesity, the correlation and determination coefficient indicated weak association between SB and obesity (e.g., BMI and %FBM). Obesity presented little or no association with SB and its pattern after adjustment for potential confounders, especially when SB is measured through accelerometry.

Resumo Embora o comportamento sedentário (CS) esteja relacionado ao desenvolvimento de doenças metabólicas, ainda não há consenso na literatura sobre a associação entre o CS avaliado diretamente por acelerometria e a obesidade, especialmente quando essa relação é ajustada por fatores de risco cardiovascular e nível de atividade física. Objetivou-se avaliar a associação entre CS e obesidade ajustada por potenciais confundidores em adultos. Foram analisados os dados de 780 participantes do Estudo Epidemiológico sobre o Movimento Humano (EPIMOV). Dados relativos à massa corporal, índice de massa corporal (IMC) e porcentagem de gordura corporal (%GC) (bioimpedância elétrica) foram obtidos e, então, utilizados para estratificar os participantes. O CS foi medido objetivamente por meio de acelerômetros triaxiais colocados sob o quadril dominante durante as horas de vigília por, pelo menos, quatro dias consecutivos (4-7 dias). O CS e seu padrão não foram significativamente diferentes entre os grupos de obesidade. Embora o CS tenha apresentado algumas correlações significativas com a obesidade, o coeficiente de correlação e determinação indicou uma fraca associação entre o CS e a obesidade (por exemplo, IMC e %GC). A obesidade apresentou pouca ou nenhuma associação com o CS e seu padrão após o ajuste para potenciais fatores de confusão, principalmente quando avaliado com acelerômetro.

Screening for physical inactivity among adults: the value of distance walked in the six-minute walk test. A cross-sectional diagnostic study.

CONTEXT AND OBJECTIVES: Accelerometry provides objective measurement of physical activity levels, but is unfeasible in clinical practice. Thus, we aimed to identify physical fitness tests capable of predicting physical inactivity among adults. DESIGN AND SETTING: Diagnostic test study developed at a university laboratory and a diagnostic clinic. METHODS: 188 asymptomatic subjects underwent assessment of physical activity levels through accelerometry, ergospirometry on treadmill, body composition from bioelectrical impedance, isokinetic muscle function, postural balance on a force platform and six-minute walk test. We conducted descriptive analysis and multiple logistic regression including age, sex, oxygen uptake, body fat, center of pressure, quadriceps peak torque, distance covered in six-minute walk test and steps/day in the model, as predictors of physical inactivity. We also determined sensitivity (S), specificity (Sp) and area under the curve of the main predictors by means of receiver operating characteristic curves. RESULTS: The prevalence of physical inactivity was 14%. The mean number of steps/day (≤ 5357) was the best predictor of physical inactivity (S = 99%; Sp = 82%). The best physical fitness test was a distance in the six-minute walk test and ≤ 96% of predicted values (S = 70%; Sp = 80%). Body fat > 25% was also significant (S = 83%; Sp = 51%). After logistic regression, steps/day and distance in the six-minute walk test remained predictors of physical inactivity. CONCLUSION: The six-minute walk test should be included in epidemiological studies as a simple and cheap tool for screening for physical inactivity.

DD Genotype and Atherosclerosis in Overweight Menopausal Women

Abstract Background Sex-specific pathology of coronary artery disease (CAD) has not been recognized. Women with obstructive or nonobstructive CAD associated with traditional risk factors have similar events; no studies have explored both populations in association with genetic markers. Objective To evaluate the DD genotype in overweight menopausal women and its association with CAD and traditional risk factors. Method This cross-sectional study included 356 menopausal women who underwent coronary angiography as CAD assessment. The patients' DNA was extracted and polymorphisms were detected with a single polymerase chain reaction assay. Two groups were formed based on luminal lesions (normal [n = 134] or pathological [n = 222]) with a cutoff value > 30%, considering overweight and age. The chi-square test, Student's t-test, and multivariate logistic regression were performed as appropriate (p < 0.05) using the following variables: overweight, diabetes, hypertension, dyslipidemia, smoking status, sedentary lifestyle, and a family history of CAD. Results The mean age of the sample was 63 + 8 years, and the mean BMI was 28 + 5 kg/m2. The DD genotype was slightly more prevalent in the pathological group (30.2% vs. 21.6%, p = 0.079), but this significantly changed when BMI > 25 was considered (33% vs. 18%, p = 0.012). In multivariate analysis with two threshold levels (> 50 and > 60 years), diabetes was significantly associated with CAD in both models (p = 0.021 vs. 0.009) but the genotype was only associated with younger age (p = 0.034). Conclusion These data support an association between atherosclerosis and the renin-angiotensin system in overweight menopausal women that is dependent on the age at which the ischemic event occurs.

Antiangiogenic and antitumoral properties of a polysaccharide isolated from the seaweed Sargassum stenophyllum.

The potential antiangiogenic and antitumoral properties of SargA, a polysaccharide extracted from the brown marine alga Sargassum stenophyllum, were studied in assays carried out in chick embryos and mice. Gelfoam plugs containing SargA (2-1500 microg/plug) implanted in vivo into fertilized 6-day-old chicken eggs induced dose-related antiangiogenic activity in the chorioallantoic membrane (CAM). By day 8, the highest dose of SargA alone decreased the vessel number in the CAM by 64%, but coadministered with hydrocortisone (156 microg/plug, which alone caused 30% inhibition) failed to potentiate its antiangiogenic effect. Combined with basic fibroblast growth factor (50 ng/plug), SargA (1500 microg/plug) abolished angiogenesis stimulated by this factor in both chick embryo CAM and in subcutaneous (s.c.) Gelfoam plugs implanted in the dorsal skin of Swiss mice (measured as plug hemoglobin content). Repeated s.c. injections of SargA (1.5 or 150 microg per animal per day for 3 days) close to B16F10 melanoma cell tumors in the dorsal skin of mice markedly decreased tumor growth in a dose-related fashion (by 40% and 80% at 2 weeks after the first injection, respectively), without evident signs of toxicity. SargA caused graded inhibitions of migration and viability of cultured B16F10 cells and also displayed antithrombotic activity in human plasma (5 mg/ml increased thrombin time 2.5-fold relative to saline). Thus, SargA exhibits pronounced antiangiogenic as well as antitumoral properties. Although the latter action of SargA might be related to the inhibition of angiogenesis, the polysaccharide also exerts cytotoxic effects on tumor cells. Because of its chemical characteristics and polyanionic constituents, we postulate that the polysaccharide SargA might modulate the activity of heparin-binding angiogenic growth factors.

Effects of oxidized LDL on in vitro proliferation and spontaneous motility of human coronary artery endothelial cells.

OBJECTIVE: To investigate the effects of low concentrations of oxidized LDL (oxLDL) on the proliferation and spontaneous motility of human coronary artery endothelial cells (HCAEC) in culture. METHODS: Cultures of HCAEC were treated with low concentrations of native LDL (nLDL) isolated from human plasma and with LDL minimally oxidized through different chemical methods; the effects were compared. RESULTS: Native LDL had no deleterious effects on in vitro proliferation and motility of HCAEC; however, at its highest concentration and for a longer exposure, nLDL inhibited cell proliferation. The LDL chemically oxidized by spermine nonoate (SNO) and 3-morpholinylsydnonimine (SYN-1) had significant inhibiting effects on in vitro proliferation and motility of HCAEC, which were proportional to the greatest concentrations and degrees of oxidation of LDL. CONCLUSION: OxLDL has a cytotoxic effect, inhibiting the proliferation and spontaneous motility of HCAEC in culture. This effect is proportional to the concentration and degree of oxidation of LDL; native LDL is relatively innocuous.

Reference values for the 6-min walk test in healthy middle-aged and older adults: from the total distance traveled to physiological responses / Valores de referência para o teste de caminhada de 6 minutos em adultos saudáveis de meia-idade e idosos: da distância total percorrida às respostas fisiológicas / Valores de referencia para la prueba de caminata de 6 minutos en adultos sanos de mediana edad y de edad avanzada: de la distancia total a las respuestas fisiológicas

Abstract Introduction: Physiological responses to the 6-min walk test (6MWT) have been increasingly evaluated in patients with cardiopulmonary diseases. However, previous studies did not include healthy persons. Objective: To evaluate the intensity of 6MWT, to develop a series of predictive equations for the physiological variables and to test their reliability in healthy middle-aged and older adults. Method: We evaluated 102 non-trained healthy adults (54 women, aged 61 ± 10 years) and a cross-validation sample of 30 participants. We measured physiological responses to the 6MWT and a cardiopulmonary exercise testing (CPET) on a treadmill. Results: The R2 values for regression analysis adjusted by age, body mass, stature, and sex ranged from 0.25 for heart rate and 0.46 for peak V ˙ O 2 The 6MWT distance and 6MWT peak V ˙ O 2 represented 110 ± 10% and 102 ± 15% of the predicted values, respectively, using our equations. The intensity of 6MWT corresponded to 72 ± 13% of the peak O2 and 78 ± 23% of the peak HR in the CPET. Peak V ˙ O 2 in the CPET was adequately predicted by 6MWT peak V ˙ O 2 (R2 = 0.76) and 6MWD (R2 = 0.54). Conclusion: The 6MWT represents a moderate to high-intensity test in middle-aged and older healthy adults and is valid for assessing maximal aerobic exercise capacity. Physiological responses to the 6MWT may be adequately predicted with a combination of anthropometrics and demographics.

Resumo Introdução: As respostas fisiológicas ao teste de caminhada de 6 minutos (TC6) têm sido cada vez mais avaliadas em pacientes com doenças cardiopulmonares. No entanto, estudos anteriores não incluíram pessoas saudáveis. Objetivo: Avaliar a intensidade do TC6, desenvolver uma série de equações preditivas para as variáveis fisiológicas e testar sua confiabilidade em indivíduos saudáveis de meia-idade e idosos. Método: Avaliamos 102 adultos saudáveis não treinados (54 mulheres, com idade de 61 ± 10 anos) e uma amostra de validação cruzada de 30 participantes. Nós medimos as respostas fisiológicas ao TC6 e ao teste de exercício cardiopulmonar (TECP) em esteira rolante. Resultados: Os valores de R2 para análise de regressão ajustados por idade, massa corporal, estatura e sexo variaram de 0,25 para frequência cardíaca e 0,46 para pico V ˙ O 2 A distância e o V ˙ O 2 no TC6 representou 110 ± 10% e 102 ± 15% dos valores previstos, respectivamente, usando nossas equações. A intensidade do TC6 correspondeu a 72 ± 13% do pico de V ˙ O 2 e 78 ± 23% do pico de frequência cardíaca no TECP. O pico de no TECP foi adequadamente previsto pelo pico de V ˙ O 2 (R2 = 0,76) e pela distância no TC6 (R2 = 0,54). Conclusão: O TC6 representa um teste de intensidade moderada a alta em adultos saudáveis de meia-idade e idosos e é válido para avaliar a capacidade máxima de exercício aeróbico. Respostas fisiológicas ao TC6 podem ser adequadamente previstas com uma combinação de dados antropométricos e demográficos.

Resumen Introducción: Las respuestas fisiológicas a la prueba de caminata de 6 minutos (PC6M) se han evaluado cada vez más en pacientes con enfermedades cardiopulmonares. Sin embargo, estudios anteriores no incluyeron a personas sanas. Objetivo: Evaluar la intensidad de la PC6M, desarrollar una serie de ecuaciones predictivas para las variables fisiológicas y probar su confiabilidad en individuos sanos de mediana edad y en ancianos. Método: Evaluamos 102 adultos sanos no entrenados (54 mujeres, con edad de 61 ± 10 años) y una muestra de validación cruzada de 30 participantes. Medimos las respuestas fisiológicas a la PC6M y a una prueba de ejercicio cardiopulmonar (PECP) en la cinta de correr. Resultados: Los valores de R2 para análisis de regresión ajustados por edad, masa corporal, estatura y sexo variaron de 0,25 para frecuencia cardíaca y 0,46 para pico O2. La distancia y el V ˙ O 2 en la PC6M representaron 110 ± 10% y 102 ± 15% de los valores previstos, respectivamente, usando nuestras ecuaciones. La intensidad de la PC6M correspondió a 72 ± 13% del pico de V ˙ O 2 y a 78 ± 23% del pico de frecuencia cardiaca en la PECP. El pico de V ˙ O 2 en la PECP fue adecuadamente previsto por el pico de V ˙ O 2 (R2 = 0,76) y por la distancia en la PC6M (R2 = 0,54). Conclusión: La PC6M representa una prueba de intensidad moderada a alta en adultos sanos de mediana edad y en ancianos y es válida para evaluar la capacidad máxima de ejercicio aeróbico. Las respuestas fisiológicas a la PC6M pueden ser previstas con una combinación de datos antropométricos y demográficos.