Marco Túlio de Mello

Obesity and metabolic syndrome in infancy and adolescence

Nas ultimas decadas a prevalencia da obesidade vem apresentando um aumento em varios paises ao redor domundo. Este fato e preocupante, ja que o excesso de gordura corporal, principalmente a abdominal, estadiretamente relacionado com alteracoes do perfil lipidico, com o aumento da pressao arterial e ahiperinsulinemia, considerados fatores de risco para o desenvolvimento de doencas cronicas, como o diabetesmelito tipo 2 e as doencas cardiovasculares. Niveis elevados de leptina e de acido urico e a alteracao dosfatores fibrinoliticos tambem tem sido observados em individuos obesos. O conjunto destas alteracoes temsido descrito como “sindrome metabolica” ou “sindrome da resistencia a insulina”, ja que a hiperinsulinemiatem um papel importante no desenvolvimento dos outros componentes da sindrome metabolica. Entretanto,questiona-se se estas alteracoes ja estao presentes em criancas e adolescentes obesos. Este artigo descreve afisiopatologia dos componentes da sindrome metabolica e esclarece como este processo ocorre na faixa etariamais jovem.

Depression, anxiety and quality of life scores in seniors after an endurance exercise program

OBJECTIVE Mood disorders are a frequent problem in old age, and their symptoms constitute an important public health issue. These alterations affect the quality of life mainly by restricting social life. The participation in a regular exercise program is an effective way of reducing or preventing the functional decline associated with aging. The aim of the present study was to examine the effects of fitness-endurance activity (at the intensity of Ventilatory Threshold 1 (VT-1)) in depression, anxiety and quality of life scores in seniors. METHODS The study involved 46 sedentary seniors aged 60-75 (66.97 +/- 4.80) who were randomly allocated to two groups: 1) Control group, which was neither asked to vary their everyday activities nor to join a regular physical fitness program; and 2) Experimental group, whose members took part in an aerobic fitness program consisting of ergometer cycle sessions 3 times a week on alternate days for six months working at a heart rate corresponding to ventilatory threshold (VT-1) intensity. Subjects were submitted to a basal evaluation using the geriatric depression screening scale--GDS, STAI trait/state (anxiety scale) and SF-36 (quality of life scale). RESULTS Comparing the groups after the study period, we found a significant decrease in depressive and anxiety scores and an improvement in the quality of life in the experimental group, but no significant changes in the control group. CONCLUSION The data suggest that an aerobic exercise program at VT-1 intensity suffices to promote favorable modifications in depressive and anxiety scores to improve the quality of life in seniors.

Paradoxical Sleep Deprivation: neurochemical, hormonal and behavioral alterations. Evidence from 30 years of research

Sleep comprises approximately one-third of a persons lifetime, but its impact on health and medical conditions remains partially unrecognized. The prevalence of sleep disorders is increasing in modern societies, with significant repercussions on peoples well-being. This article reviews past and current literature on the paradoxical sleep deprivation method as well as data on its consequences to animals, ranging from behavioral changes to alterations in the gene expression. More specifically, we highlight relevant experimental studies and our groups contribution over the last three decades.

Effects of moderate aerobic exercise training on chronic primary insomnia

OBJECTIVE To evaluate the effect of long-term moderate aerobic exercise on sleep, quality of life, and mood of individuals with chronic primary insomnia, and to examine whether these effects differed between exercise in the morning and exercise in the late afternoon. METHODS Nineteen sedentary individuals with chronic primary insomnia, mean age 45.0 (standard error [SE] 1.9) years, completed a 6-month exercise training protocol, randomized to morning and late-afternoon exercise groups. RESULTS Combining polysomnographic data across both time points, this study found a significant decrease in sleep onset latency (from 17.1 [SE 2.6] min to 8.7 [SE 1.4] min; P<0.01) and wake time after sleep onset (from 63.2 [SE 12.8] min to 40.1 [SE 6.0] min), and a significant increase in sleep efficiency (from 79.8 [SE 3.0]% to 87.2 [SE 1.6]%) following exercise. Data from sleep diaries revealed significant improvement in sleep onset latency (from 76.2 [SE 21.5] min to 80.3 [SE 7.4] min) sleep quality (from 41.5 [SE 5.2]% to 59.4 [SE 6.6]%) and feeling rested in the morning (from 50.8 [SE 5.3] to 65.1 [SE 5.0]). There were generally no significant differences in response between morning and late-afternoon exercise. Following exercise, some quality-of-life measures improved significantly, and a significant decrease was seen in the following Profile of Mood State measures: tension-anxiety (from 7.2 [SE 1.0] to 3.5 [SE 1.0]), depression (from 5.9 [SE 1.2] to 3.3 [SE 1.1]) and total mood disturbance (from 9.2 [SE 4.8] to -1.7 [SE 4.8]). These effects did not vary between morning and late-afternoon exercise. CONCLUSION Long-term moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia.

HYPERSOMNOLENCE AND ACCIDENTS IN TRUCK DRIVERS: A CROSS-SECTIONAL STUDY

Truck drivers are more likely to suffer severe injury and death due to certain truck driving characteristics. Identifying and preventing factors associated with accidents in this population is important to minimize damage and improve road safety. Excessive daytime sleepiness is a major public health problem, leading to impaired cognitive function, reduced alertness, and increased risk of motor vehicle crashes. The aim of this cross‐sectional study was to determine the prevalence and predictors of hypersomnolence (defined as an Epworth Sleepiness Scale score greater than 10) among truck drivers. Three hundred male truck drivers were studied. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index, and the association between demographic, clinical, and occupational data with excessive sleepiness was analyzed. The mean daily sleep duration was 5.6±1.3 h, and poor quality of sleep was found in 46.3% of the individuals. Hypersomnolence was found in 46% of the drivers and was associated with younger age, snoring, and working >10 h without rest. A positive correlation between hypersomnolence and previous accidents was detected (p=0.005). These results show that sleep deprivation and hypersomnolence are frequent among truck drivers. The treatment of sleep‐disordered breathing and the implementation of educational programs, particularly targeting younger drivers and promoting increased awareness of the deleterious effects of sleep loss and work overload, may help to reduce hypersomnolence and accidents among truck drivers.

Exercício físico e função cognitiva: uma revisão

RESUMO O exercicio e o treinamento fisico sao conhecidos por promover diversas alteracoes, incluindo beneficios cardiorrespiratorios, aumento da densidade mineral ossea e diminuicao do risco de doencas cronico-degenerativas. Recentemente outro aspecto tem ganhando notoriedade: trata-se da melhoria na funcao cognitiva. Embora haja grande controversia, diversos estudos tem demonstrado que o exercicio fisico melhora e protege a funcao cerebral, sugerindo que pessoas fisicamente ativas apresentam menor risco de serem acometidas por desordens mentais em relacao as sedentarias. Isso mostra que a participacao em programas de exercicios fisicos exercem beneficios nas esferas fisica e psicologica e que, provavelmente, individuos fisicamente ativos possuem um processamento cognitivo mais rapido. Embora os beneficios cognitivos do estilo de vida fisicamente ativo parecam estar relacionados ao nivel de atividade fisica regular, ou seja, exercicio realizado durante toda a vida, sugerindo uma “reserva cognitiva”, nunca e tarde para se iniciar um programa de exercicios fisicos. Dessa forma, o uso do exercicio fisico como alternativa para melhorar a funcao cognitiva parece ser um objetivo a ser alcancado, principalmente em virtude da sua aplicabilidade, pois se trata de um metodo relativamente barato, que pode ser direcionado a grande parte da populacao. Assim, o objetivo da presente revisao e o de discutir os aspectos associativos entre exercicio fisico e funcao cognitiva, permitindo uma ponderacao entre o seu uso enquanto alternativa e elemento coadjuvante.

O exercício físico e os aspectos psicobiológicos

Physical exercise and the psychobiological aspects The objective of this review is to address part of the studies on an issue not much explored: the relation between physical exercise and the psychobiological aspects. The importance of understanding these aspects and how they affect the quality of life of the human being is what stimulates researches on this issue. The literature stresses the fact that the regular practice of physical exercise produces positive results not only regarding sleep and its possible disorders, but also regarding the psychological aspects and the mood disorders, such as anxiety and depression, and the cognitive aspects, such as memory and learning. However, there are individuals who engage in the practice of physical exercise with such intensity and/or frequency, or yet, who make use of illegal drugs that can bring harmful effects to their health, as the case of physical exercise dependents and anabolic steroids users. Physical exercises cause physiological, biochemical and psychological alterations and, therefore, may be considered as a non-medication intervention for the treatment of disorders associated to the psychobiological aspects.

Sleep disorders, sleepiness and traffic safety: a public health menace

Sleep disorders are not uncommon and have been widely reported throughout the world. They have a profound impact on industrialized 24-h societies. Consequences of these problems include impaired social and recreational activities, increased human errors, loss of productivity, and elevated risk of accidents. Conditions such as acute and chronic insomnia, sleep loss, excessive sleepiness, shift-work, jet lag, narcolepsy, and sleep apnea warrant public health attention, since residual sleepiness during the day may affect performance of daily activities such as driving a car. Benzodiazepine hypnotics and zopiclone promote sleep, both having residual effects the following day including sleepiness and reduced alertness. In contrast, the non-benzodiazepine hypnotics zolpidem and zaleplon have no significant next-day residual effects when taken as recommended. Research on the effects of wakefulness-promoting drugs on driving ability is limited. Countermeasures for excessive daytime sleepiness have a limited effect. There is a need for a social awareness program to educate the public about the potential consequences of various sleep disorders such as narcolepsy, sleep apnea, shift-work-related sleep loss, and excessive daytime sleepiness in order to reduce the number of sleep-related traffic accidents.

Metabolic and Nutritional Profile of Obese Adolescents With Nonalcoholic Fatty Liver Disease

Background: The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program. Patients and Methods: We studied 43 adolescents ages 15 to 19 years (17.18 ± 1.66 years) with a body mass index (BMI) ≥30, consisting of 30 patients without NAFLD (BMI = 35.80 ± 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 ± 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry. Results: At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy. Conclusions: The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.

Sleep and sleepiness among Brazilian shift-working bus drivers.

The aim of this study was to evaluate daytime and nighttime sleep, as well as daytime and nighttime sleepiness of professional shift-working bus drivers. Thirty-two licensed bus drivers were assessed by nocturnal and diurnal polysomnography (PSG) recording and multiple sleep latency testing (MSLT) sessions. Sleep length was shorter and sleep efficiency reduced during daytime sleep compared with nighttime sleep. Thirty-eight percent of the drivers had indices of obstructive apnea and hypopnea syndrome (>5/h sleep) during nighttime and daytime sleep; more drivers snored during daytime than nighttime sleep (50% vs. 35%, p < 0.05), and 38% of the drivers evidenced periodic leg movements. The MSLT revealed that 42 and 38% of the bus drivers met the criteria for sleepiness when the test was conducted during the day and night, respectively. The daytime as compared to nighttime sleep of shift-working bus drivers was shorter and more fragmented and was associated in many with evidence of excessive sleepiness. Respiratory disorder was a common finding among the professional shift-working bus drivers. All these sleep deficiencies may adversely affect on the job driving performance.