Fernanda Rodrigues de Oliveira Penaforte

Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome

BACKGROUND Fat accumulation in the upper region of the body is common in polycystic ovary syndrome (PCOS) and is associated with metabolic complications. The present study aimed to assess the relationship between trunk circumference, metabolic indicators, and abdominal and visceral fat in obese PCOS women. METHODS The weight, fat mass, and subcutaneous arm fat (SAF) of 30 obese PCOS women and 15 healthy controls matched for age and body mass index were evaluated by bioelectrical impedance analysis. Trunk (TrC), neck (NC) and hip circumferences were measured, and the trunk/hip (Tr/H) ratio was determined. Total abdominal fat (TAF), visceral fat (VF) and trunk fat (TrF) were determined by computed tomography. Biochemical evaluation included glycaemia, insulinaemia, testosterone and lipid profile, insulin resistance (IR) was assessed by the QUICKI index. RESULTS In the PCOS group, there were positive correlations between NC and TAF (r = 0.49, P < 0.0006), TrC and VF (r = 0.62, P = 0.01), and NC and VF (r = 0.70, P < 0.0002). There was good correlation between TrC and TrF (r = 0.69, P = 0.003). TrF correlated with triglycerides levels positively (r = 0.44, P = 0.02). Women with PCOS and IR had a larger quantity of VF and TrF, but a smaller amount of SAF. Within the PCOS group, women with Tr/H ratio above the median had higher basal insulin levels and lower QUICKI indices compared to women presenting a Tr/H ratio below the median. CONCLUSIONS TrC is associated with important metabolic variables in PCOS, proving to be a valuable and innovative tool for assessment of body adiposity distribution in obese PCOS women.

Weight and body composition variations in overweight women along outpatient nutritional treatment

INTRODUCTION To evaluate the treatment of obesity it is necessary to understand the weight changes, to improve intervention strategies. OBJECTIVE To assess the progression of weight and body parameters in overweight women along a diet therapy. METHODS 163 women participated in this study. They were evaluated for weight, circumferences (waist and hip), and body composition (lean mass and body fat) along the three treatment phases. RESULTS AND DISCUSSION The weight loss percentage was higher in the first treatment phase than in the second one (-6.8 ± 4.8% vs. -4.0 ± 2.7%, p < 0.0001). In the two first phases the circumferences and the lean mass decreased among women with weight loss. Body fat reduction occurred (-2.6%) during the first phase only. CONCLUSION Weight loss and reduction in body parameters occurred mainly in the first treatment phase, showing that it is necessary to rethink intervention strategies.

Imbalance Between Postprandial Ghrelin and Insulin Responses to an Ad Libitum Meal in Obese Women With Polycystic Ovary Syndrome

Obese women with polycystic ovary syndrome (PCOS) may have impairment in the regulation of food intake associated with ghrelin and insulin. In order to compare postprandial ghrelin and insulin responses to an ad libitum meal, we assessed 30 obese women with PCOS and 23 obese women without PCOS (control group). Blood samples were taken under fasting conditions, preprandially, and 15, 45, 75, and 135 minutes after the beginning of an ad libitum meal and ghrelin and insulin concentrations were analyzed. Insulin resistance (IR) was classified using basal insulin, quantitative insulin sensitivity check index, and homeostasis model assessment index. Mean ad libitum food intake was similar between the groups (468 ± 150 vs 444 ± 165 g, P = .60). The IR was found in 56.6% in PCOS group compared with 30.4% in the control group (P < .01). The postprandial ghrelin response was similar in both the groups but the insulin area under the curve (AUC) tend to be greater in the PCOS group (12807 ± 8149.4 vs 8654.4 ± 7232.3 μIU/mL/min; P = .057). The ghrelin AUC was negatively correlated with the insulin AUC (r = −.5138; P = .01) only in the control group. The imbalance in the feedback mechanisms between insulin and ghrelin, present in obese women, especially those with IR, may affect food intake throughout the day and that could be a mechanism for the development of obesity in PCOS.

Hospital nutritional care: propositions endorsed by the scientific community

BACKGROUND/OBJECTIVES the incidence of hospital undernutrition and its consequences for both the patient and the hospital has demanded procedures that ensure the delivery of good-quality hospital nutritional care. On the basis of literature reports, this study aimed to build a hospital nutritional care propositions that the scientific community later evaluated and endorsed. METHODS forty-one propositions concerning patient clinical nutritional care and hospital food service management by the Hospital Nutrition and Food Service were designed. One hundred professionals, researchers, and professors evaluated the propositions. Agreement with the propositions was analyzed by means of a five-point Likert scale (I strongly disagree; I partially disagree; I have no opinion; I partially agree; I totally agree) associated with each proposition. Agreement was considered to occur when 70% or more of the interviewees agreed (partially or totally) with the proposition. The procedure Proc Corresp of the software SAS 10, version 8, aided descriptive statistics and correspondence analysis. RESULTS more than 90% of the interviewees completely or partially agreed with 85% (35) of the 41 propositions; between 80 and 90% of the interviewees totally or partially agreed with 15% (6) of the 41 propositions. All the proposed criteria had over 70% agreement (total and partial). The lowest value of total agreement was 70%, attributed to the proposition that suggested patients participation in nutritional intervention. CONCLUSIONS the scientific community presented high level of agreement with the hospital nutritional care propositions, which suggested an important consensus about it.

TREATMENT FOR WEIGHT LOSS OF GRADE III OBESE PATIENTS IN THE HOSPITAL ENVIRONMENT: COMPARATIVE STUDY BETWEEN HOSPITALIZATION AND AMBULATORY PROGRAMS

Introduccion: La obesidad es una enfermedad caracterizada por la acumulacion excesiva de grasa corporal, con efectos nocivos para la salud. Objetivo: Evaluar el impacto de dos programas para el tratamiento de la obesidad grado III: hospitalizacion y ambulatorio, en la perdida de peso y composicion corporal. Metodo: Se realizo un estudio retrospectivo basado en el analisis de las historias clinicas de los pacientes sometidos a los dos programas, entre 1990 y 2005, con la evaluacion de la evolucion del peso, circunferencias corporales (cadera, abdominal, y del brazo), la masa grasa (MG, kg) y masa libre de grasa (MLG, kg). Resultados: Un total de 50 historias clinicas fueron evaluadas, siendo la mayoria (54%), de los pacientes del programa de hospitalizacion (PH). Los dos programas fueron eficaces en la promocion de la perdida de peso, pero esta perdida fue mayor para el PH; que llevo a una reduccion de todas las medidas de las circunferencias corporales y de la MG. Sin embargo, su costo fue 80 veces mayor que el del programa de ambulatorio. Conclusion: Sobre la base de los datos evaluados, a pesar de su costo mucho mas alto, el HP dio resultados mas eficaces en terminos de perdida de peso y en el cambio de la composicion corporal.