Cintia Curioni

Long term pharmacotherapy for obesity and overweight: updated meta-analysis

Objective To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status. Design Updated meta-analysis of randomised trials. Data sources Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006. Studies reviewed Double blind randomised placebo controlled trials of approved anti-obesity dugs used in adults (age over 18) for one year or longer. Results 30 trials of one to four years’ duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine lowered concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders. Conclusions Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.

Association between eating out of home and body weight.

Eating outside of the home environment on a frequent basis has been associated with weight gain. Food choices when eating out are usually high in energy content, which contributes to excessive energy intake; however, the available data on out-of-home eating and obesity are far from conclusive. This systematic review assesses the association between out-of-home eating and body weight in adults over 18 years of age. The literature databases searched included Medline, Embase, Lilacs, The Cochrane Library, and the ISI Web of Knowledge. The review includes a comprehensive quality assessment of all included observational studies, 20 cross-sectional studies, and 8 prospective cohort studies. All but one of the prospective cohort studies and about half of the cross-sectional analyses found a positive association between out-of-home eating and body weight. However, many methodological differences among the studies were found, such as the definition of out-of-home eating and its assessment, which limits comparisons. The results of the present analysis suggest that in future studies fast-food restaurants and other out-of-home dining venues should be analyzed separately, assessments based on a single 24-h recall should be avoided, and controls for at-home choices (which were not included in any of the studies reviewed) are necessary to evaluate this association.

The decline in mortality from circulatory diseases in Brazil

OBJECTIVES Cardiovascular diseases are the leading cause of death in the world. Although mortality rates have declined gradually in developed countries, the scenario is less clear in developing countries. We describe the trends in cardiovascular mortality in Brazil over 24 years and investigate differences according to groups of diseases, sociopolitical region, gender, and age. METHODS We retrieved official data on mortality and population estimates to calculate standardized mortality rates in six age strata and in the five political regions from 1980 through 2003. The negative binomial distribution model was used to estimate trends for mortality separately for each gender, age group, and geopolitical region during this period. RESULTS Total cardiovascular standardized mortality rates decreased consistently over 24 years, from 287.3 to 161.9 per 100,000 inhabitants, with a mean annual decrease of 3.9%. Reductions in cardiovascular standardized mortality rates were detected in all strata and for all groups of diseases, with stroke exhibiting the largest average decline, from 95.2 to 52.6 per 100,000 inhabitants (mean 4.0% per year), followed by coronary disease, from 80.3 to 49.2 per 100,000 inhabitants (3.6% per year); the decrease was especially marked in the most developed regions. CONCLUSIONS Cardiovascular disease standardized mortality rates consistently decreased in Brazil during the study period. The reduction is apparently related to indices of increasing social development. Despite these encouraging findings, a gradual increase in the deaths from cardiovascular disease is expected in the next decades, and additional efforts in prevention are needed.

Progressive Decline in Stroke Mortality in Brazil From 1980 to 1982, 1990 to 1992, and 2000 to 2002

Background and Purpose— We describe the trends in stroke mortality in Brazil during 3 decades and investigate their differences according to regional disparities, sex, and age distributions. Methods— Official data on mortality and population estimates were retrieved to calculate standardized mortality rates (with the 1980 Brazilian population as a reference) in 6 age strata and in the 5 political regions for the initial period (3 first years) of the 1980, 1990, and 2000 decades. Data were corrected for undefined causes of death. The Poisson model was used to estimate risk reduction during the 3 decades and to study the interaction between those rates and sex, age strata, and regions. Results— The stroke standardized mortality rate decreased consistently in the last 20 years, from 68.2 to 40.9 per 100 000 habitants. This reduction paralleled a decrease in total cardiovascular mortality rates in the same period, from 208.2 to 126.1 per 100 000 habitants. The reduction in stroke standardized mortality rate was detected in men and women and in all age strata. The reduction was evident in all geopolitical regions of the country, with the wealthiest regions’ exhibiting higher initial rates and more marked standardized mortality rate reductions. The risk of dying of stroke in the period 2000 to 2002 was 0.45 (95% CI, 0.44 to 0.45) of that found in the period 1980 to 1982. Conclusions— The risk of dying of stroke in Brazil declined dramatically between the initial period in the early 1980s and the early 2000s. The decline was especially marked in the most developed regions and may reflect an improvement in general health conditions during the study period.

Influence of menu labeling on food choices in real-life settings: a systematic review.

CONTEXT Evidence that menu labeling influences food choices in real-life settings is lacking. Reviews usually focus on calorie counts without addressing broader issues related to healthy eating. OBJECTIVE This systematic review assessed the influence of diverse menu-labeling formats on food choices in real-life settings. DATA SOURCES Several databases were searched: Cochrane Library, Scopus, MEDLINE, Web of Science, Food Science and Technology Abstracts, Biological Abstracts, CAB Abstracts, EconLit, SciELO, and LILACS. STUDY SELECTION Articles reporting experiments, quasi-experiments, and observational studies using control or preintervention groups were selected blindly by two reviewers. DATA EXTRACTION Data was extracted using a standard form. Analyses differentiated between foodservice types. The quality of the 38 included studies was assessed blindly by two reviewers. DATA ANALYSIS The results were mixed, but a partial influence of menu labeling on food choices was more frequent than an overall influence or no influence. Menu labeling was more effective in cafeterias than in restaurants. Qualitative information, such as healthy-food symbols and traffic-light labeling, was most effective in promoting healthy eating. In general, the studies were of moderate quality and did not use control groups. CONCLUSIONS Calorie labeling in menus is not effective to promote healthier food choices. Further research in real-life settings with control groups should test diverse qualitative information in menu labeling.

Comment on: “Effect of Exercise Training on Non-exercise Physical Activity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”

Physical exercise is widely regarded as an important component in obesity prevention programs, mainly because of its effects on energy expenditure [1], though some studies do not support this idea [2, 3]. Fedewa et al. [4] evaluated the effect of exercise training on non-exercise physical activity (NEPA) in a systematic review with metaanalysis of randomized controlled trials. The results showed no statistically significant change in NEPA in response to exercise training, though duration of the exercise sessions and intervention length were significantly associated with change in NEPA. Longer training sessions led to a decrease in NEPA, while a longer intervention was associated with an increase in NEPA. While interesting, some important limitations of the findings of this review require clarification. Although recognized by the authors as a limitation of the review, information about the search strategy was poorly depicted. A combination of only five search terms was used to describe exposure/outcome, and only two search terms were used as a filter for identifying randomized trials. This is an important issue because the review’s conclusions could be over-influenced by studies that are simply the easiest to find. Therefore, for an exhaustive search of the literature, a better search strategy is necessary. The most critical issue regards the meta-analysis. The authors described data from 11 studies, yielding a total of 44 effects in quantitative synthesis. The overall effect shown in the forest plot indicated that no significant change in NEPA occurred during exercise training. However, it is not clear in the article how the results were combined in just one forest plot. Thereafter, the authors identified the dependencies between the effect sizes within the multiple-treatment studies and multiple-endpoints studies included in the review and performed a multilevel linear regression. A serious limitation for a multilevel meta-analysis is related to correlations between measures [5, 6]. According to Gleser and Olkin [6], the correlations between estimated effect sizes in multiple-endpoints studies are intrinsic to such studies, whereas the correlations between the effects sizes from multiple-treatment studies are an artifact of the design. Therefore, covariances between estimated effect & Vitor Barreto Paravidino vparavidino@gmail.com

SMOKING STATUS AFFECTS BIOIMPEDANCE-DERIVED PHASE ANGLE IN MEN BUT NOT IN WOMEN: THE PRÓ-SAÚDE STUDY, BRAZIL

OBJECTIVE Phase angle (PhA) is determined by bioelectrical impedance (BIA) and it is interpreted as an index of cell membrane integrity. Smokers are susceptible to systemic oxidative stress and often adopt unhealthy habits, which may contribute to cellular damage. This unfavorable conjuncture may result in lower PhA in smokers. The aim of this study was to investigate the association between PhA and smoking status. METHODS This cross-sectional study included 247 (48%) adult men. Body composition and PhA were determined using dual-energy x-ray absorptiometry and BIA, respectively. Blood sampling, food habits, and smoking status information were collected. Statistical analyses were performed for each sex separately. Analysis of covariance controlling for body mass index and age compared PhA values across smoking categories. Multiple linear regression determined whether smoking status was a PhA predictor. RESULTS PhA was lower in male current smokers (6.6 ± 0.13°) compared with never-smokers (7 ± 0.06°; P = 0.038). The ratio of extracellular to intracellular water was higher in current (P = 0.003) and former male smokers (P = 0.006) compared with never-smokers. Body composition did not differ in male and female smoking categories. Male current smokers ingested more calories, protein, carbohydrates, and alcohol than never and former smokers (P < 0.05). Current female smokers had higher alcohol consumption compared with never smokers (P = 0.019). Male current smokers presented lower than never-smokers (unstandardized β coefficient = -0.202; 95% confidence interval, -0.359 to -0.046). Smoking status was associated with PhA decrease only in men. CONCLUSION The results from the present study suggest that being a current smoker results in lower PhA in men, even when controlling for other variables.

Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study

ABSTRACT Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high‐income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self‐administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13‐year trajectories of non‐work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index ‐ NDVI ‐ derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6‐fold higher odds (aOR: 2.62, 95% CI: 1.37–5.01) of reporting non‐work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables. HIGHLIGHTSEvidence is limited on relationships between natural and built environment and physical activity in LMIC.We expand knowledge by investigating in Rio de Janeiro associations between a 13‐year trajectory of physical activity and 8 indicators of natural and built environment.Reconnections between public health and urban planning are crucial given global trends in urbanization and health inequalities.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies

OBJECTIVE To review the association between intimate partner violence and breastfeeding practices in the literature. DATA SOURCES The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review. SUMMARY OF DATA The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the childs life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items. CONCLUSIONS Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.