Cintia Cercato

Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population

OBJECTIVE To determine the prevalence of systemic hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia in a Brazilian population in relation to body mass index. METHOD Retrospective evaluation of 1213 adults (mean age: 45.2 +/- 12.8; 80.6% females) divided into groups according to body mass index [normal (18.5 - 24.4 kg/m2); overweight (25 - 29.9 kg/m2); grade 1 obesity (30 - 34.9 kg/m2); grade 2 obesity (35 - 39.9 kg/m2), and grade 3 obesity (> or = 40 kg/m2)]. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were analyzed in each group. The severity of cardiovascular risk was determined. High-risk patients were considered those reporting 2 or more of the following factors: systemic hypertension, HDL < or = 35 mg/dL, total cholesterol > or = 240 mg/dL, triglycerides > or = 200 mg/dL when HDL < or = 35 mg/dL, and glycemia > or = 126 mg/dL. Moderate-risk patients were those reporting 2 or more of the following factors: systemic hypertension, HDL < or = 45, triglycerides > or = 200 mg/dL, and total cholesterol > or = 200 mg/dL. RESULTS The prevalence of systemic hypertension, diabetes mellitus, hypertriglyceridemia, and low HDL-cholesterol levels increased along with weight, but the prevalence of hypercholesterolemia did not. The odds ratio adjusted for gender and age, according to grade of obesity compared with patients with normal weight were respectively 5.9, 8.6, and 14.8 for systemic hypertension, 3.8, 5.8, and 9.2 for diabetes mellitus and 1.2, 1.3, and 2.6 for hypertriglyceridemia. We also verified that body mass index was positively related to cardiovascular high risk (P < .001) CONCLUSION In our population, cardiovascular risk increased along with body mass index.

Effect of gastric bypass on spontaneous growth hormone and ghrelin release profiles.

Objective: The purpose of this study was to analyze growth hormone (GH) concentrations in obese women before and after Roux‐en‐Y gastric bypass (RYGBP) and how resulting changes in weight, fat mass, ghrelin levels, and insulin sensitivity affect GH secretion.

Changes in Neuropsychological Tests and Brain Metabolism After Bariatric Surgery

CONTEXT The mechanisms by which obesity alters the cerebral function and the effect of weight loss on the brain have not been completely clarified. OBJECTIVE The objective of the study was to assess the effect of bariatric surgery on the cognitive function and cerebral metabolism. DESIGN Seventeen obese women were studied prior to and 24 weeks after bariatric surgery using neuropsychological tests and positron emission tomography. SETTING The study was conducted in a reference center for the treatment of obesity of a Brazilian public university. PARTICIPANTS Thirty-three women paired by age and level of education made up two groups: 17 severely obese patients and 16 lean patients. They did not have diabetes mellitus or a family history of dementia. MAIN OUTCOME MEASURES Comparison of performance in neuropsychological tests and cerebral metabolism of the obese women before and after bariatric surgery was measured. The results found at the two moments were compared with those of the women of normal weight. RESULTS Women with a mean age of 40.5 years and mean body mass index of 50.1 kg/m(2) when compared with women with mean body mass index of 22.3 kg/m(2) showed increased cerebral metabolism, especially in the posterior cingulate gyrus (P < .004). No difference was found between the groups for the neuropsychological tests. After 24 weeks the cerebral metabolism of the obese women was lower, similar to the lean women, and there was an improvement of executive function, accompanying changes of metabolic and inflammatory parameters. CONCLUSIONS Obese women may have increased cerebral metabolism when compared with women of normal weight, and this appears to reverse after weight loss induced by bariatric surgery, accompanied by improved executive function.

Cognitive Effects of Intentional Weight Loss in Elderly Obese Individuals With Mild Cognitive Impairment

CONTEXT Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment. OBJECTIVE To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet. DESIGN Single-center, prospective controlled trial. SETTING Academic medical center. PARTICIPANTS Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers). INTERVENTION Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months. OUTCOME MEASUREMENTS clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls. RESULTS Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests. CONCLUSIONS Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.

Eixos hormonais na obesidade: causa ou efeito?

Several endocrine changes have been described in the obesity state. The corticotropic axis is hyperresponsive and there is enhancement of hormonal clearance, but cortisol levels are within the normal range. It is important to characterize a pseudo-Cushing in obesity. Leptin seems to be a permissive hormone for the beginning of puberty. In adults, gonadotropines are normal, and hyperandrogenism and hyperestrogenism are found. In women, insulin resistance has a central role in polycystic ovarian syndrome (POS), which is associated to ovarian hyperandrogenemia. In obese subjects, growth hormone (GH) is generally low and IGF1 is normal. Thyroid function is commonly normal in obese subjects.

Combinations of Drugs in the Treatment of Obesity.

Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, however, currently offers disappointing results, with very high rates of weight loss failure or weight regain cycles, and only two drugs (orlistat and sibutramine) approved for long-term use. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. Our review focuses on the rationale for their use, with advantages and disadvantages; on combinations often used, with or without studies; and on new perspectives of combinations being studied mainly by the pharmaceutical industry.

Results of Biliopancreatic Diversion in Two Patients with Prader-Willi Syndrome

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by hypotonia, mental retardation or learning disability, hyperphagia and compulsive eating due to hypothalamic dysfunction. Obesity is a major cause of increased morbidity and mortality among patients with PWS. Gastric restrictive surgery has been associated with partial breakdown of the staple-line in PWS. We report two patients with PWS associated with morbid obesity and obstructive sleep apnea who underwent biliopancreatic diversion (BPD). A 27-year-old male with BMI 52 kg/m2 and a 20year-old female with BMI 64 kg/m2 underwent BPD. No perioperative complications were observed. After BPD, the males BMI was 36.7 kg/m2 at 12 months and the females BMI was 48.4 kg/m2 at 28 months, with excess weight loss 58% and 48%, respectively. They developed loose stools associated with eating. These patients have shown a considerable improvement in hypersomnia and respiratory difficulties. BPD proved to be an effective approach to weight loss in PWS, resulting in improvement of sleep apnea, behavior problems and quality of life.

Análise da taxa metabólica de repouso avaliada por calorimetria indireta em mulheres obesas com baixa e alta ingestão calórica

ABSTRACT Analysis of Resting Metabolic Rate Evaluated by Indirect Calorime-try in Obese Women With Low and High Caloric Intake.The aim of this study was to evaluate if obese women with the lowest values of caloric intake (CI) determined by food questionnaire also present the low-est values of resting metabolic rate (RMR), which could lead to excessive weight gain, caused by changes in energy balance. With this porpouse, 77 obese women, with IMC> 30kg/m 2 , aged 20 to 45 years, had their physical activity level and CI evaluated. According to the values of CI obtained from food intake reports, the participants were divided in 3 groups: low (G1), me-dium (G2), high (G3) CI and were submitted to indirect calorimetry. Height, weight, body surface area (BSA), fat free mass and fat mass measured by bioimpedance were evaluated. The highest values of weight, BSA an fat mass were obtained in G1, as well as values above 1.2 for the CI:RMR ratio, which indicates a probable underestimation of CI. The highest values of physical activity and RMR were observed in the G3 (with high caloric intake). In conclu-sion, this paper shows that a tendency towards underestimation of self-re-ported caloric intake exists among obese women and that the maintenance of weight in some patients can be due to their low level of physical activity.

Abordagem terapêutica da obesidade na Síndrome de Prader-Willi

Prader-Willi Syndrome (PWS) is a multisystemic genetic disease characterized by hypotonia, mental retardation, characteristic facial appearance, hyperphagia, and compulsive eating due to hypothalamic dysfunction. PWS is caused by loss of function of genes located in chromosome 15q11-q13, an area subject to genomic imprinting. Obesity is a major cause of increased morbidity and mortality among patients with PWS. The objective of this study was to analyze the therapeutic options available for the treatment of the obesity in PWS including pharmacological and surgical strategies.

Efeito do hormônio de crescimento sobre parâmetros antropométricos e metabólicos na obesidade andróide

O objetivo do estudo foi avaliar os efeitos do GH sobre peso, composicao corporal, metabolismo de repouso e fatores de risco cardiovascular na obesidade visceral. O estudo foi prospectivo randomizado duplo-cego em 40 homens nao diabeticos de 20 a 50 anos com RAQ (relacao abdomen-quadril) > 1 tratados com GH (0,050 U/kg/dia) ou placebo por tres meses. Foram avaliados peso, composicao corporal por bioimpedância e DEXA, metabolismo de repouso atraves da calorimetria indireta e exames de fatores de risco cardiovasculares no inicio e fim do tratamento. O grupo de obesos tratados com GH teve reducoes de peso (3,5 ± 2,9 kg), IMC (1,2 ± 1,0 kg/m2), RAQ (0,04 ± 0,01) e massa adiposa (2,4 ± 1,0 kg). As reducoes porcentuais foram significantemente diferentes das observadas no grupo placebo. Tambem houve diminuicao nos niveis de colesterol total (4,0 ± 3,3 mg/dL) e LDL-colesterol (5,7 ± 2,7 mg/dL) no grupo GH, em relacao ao grupo placebo. Os outros fatores de risco nao se alteraram significantemente. Concluimos que obesos tratados com GH por tres meses apresentaram uma reducao significante de peso corporal, gordura visceral e massa adiposa, e melhora do perfil lipidico. O beneficio/risco do GH a longo prazo em obesos e desconhecido.