Rosana Bento Radominski

Posicionamento oficial da Sociedade Brasileira de Medicina do Esporte e da Sociedade Brasileira de Geriatria e Gerontologia: atividade física e saúde no idoso

Antonio Claudio Lucas da Nobrega, Elizabete Viana de Freitas, Marcos Aurelio Brazao de Oliveira,Marcelo Bichels Leitao, Jose Kawazoe Lazzoli, Ricardo Munir Nahas, Claudio Aparicio Silva Baptista,Felix Albuquerque Drummond, Luciano Rezende, Josbel Pereira, Maurilio Pinto,Rosana Bento Radominski, Neiva Leite, Edilson Schwansee Thiele, Arnaldo Jose Hernandez,Claudio Gil Soares de Araujo, Jose Antonio Caldas Teixeira, Tales de Carvalho,Serafim Ferreira Borges e Eduardo Henrique De Rose

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life.The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations.The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success.The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.

Effects of physical exercise and nutritional guidance on metabolic syndrome in obese adolescents

OBJETIVOS: Analisar os efeitos de exercicios fisicos (EF) e orientacao nutricional (ON) sobre a composicao corporal, aptidao fisica, perfil lipidico e resistencia insulinica em adolescentes obesos com e sem sindrome metabolica (SM). METODOS: 64 obesos (26 meninos), com idade entre 10 a 16 anos, divididos em dois grupos: com SM (n=29) e sem SM (n=35). Utilizou-se como criterio de classificacao de SM a presenca de tres ou mais criterios para idade e sexo de acordo com Adult Treatment Panel III (ATP III). Mensuraram-se antes e apos 12 semanas de intervencao: pressao arterial, circunferencia abdominal, consumo maximo de oxigenio (VO2pico), glicemia, insulinemia, Homeostatic Metabolic Assessments (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) e perfil lipidico. Os dois grupos participaram de 12 semanas de EF e duas sessoes de ON. Cada sessao de EF consistiu em 50 minutos de ciclismo indoor, 50 minutos de caminhada e 20 minutos de alongamento, tres vezes por semana. RESULTADOS: 55 sujeitos (com SM=25; sem SM=30) completaram o tratamento. Apos 12 semanas, houve diminuicao na massa corporal, IMC escore-z, circunferencia abdominal, massa gorda, TG e aumento na estatura, HDL-C e VO2pico, em ambos os grupos. Alem disso, houve uma reducao na pressao arterial sistolica, aumento na sensibilidade a insulina (p<0,05) no grupo com SM. Os fatores de risco para SM diminuiram em 72%. CONCLUSAO: Apos a intervencao multidisciplinar, houve uma reducao nos fatores de risco, melhorando a aptidao fisica e perfil metabolico. A intervencao multidisciplinar foi efetiva para reducao da SM.

Low-normal or high-normal thyrotropin target levels during treatment of hypothyroidism: a prospective, comparative study.

BACKGROUND Recent literature advocates the decrease of the upper limit of the normal thyrotropin (TSH) reference range. The objective of this study was to determine whether treated hypothyroid patients maintained within a low-normal TSH range (0.4-2.0 mIU/L) have better clinical outcomes than those maintained within a high-normal TSH range (2.0-4.0 mIU/L). METHODS The study was performed in a thyroid outpatient clinic of a tertiary hospital. This was a prospective, interventional study. Forty-two participants with newly diagnosed overt primary hypothyroidism were paired in two groups: group 1 (n=20), low-normal target TSH; group 2 (n = 22), high-normal target TSH. Levothyroxine was initiated, and dose was adjusted to achieve and sustain the target TSH value during the study period. After the target TSH was reached, participants were evaluated every 3 months for thyroid function, serum lipid profile, resting energy expenditure (REE), body composition, and bone mineral density, for 12 months. RESULTS Nineteen patients in group 1 and 16 in group 2 completed the study. In the whole-group analysis, total cholesterol (p = 0.01), low-density lipoprotein cholesterol (p = 0.004), and triglycerides (p < 0.001) decreased after treatment, whereas REE per kilogram of lean body mass (p = 0.001) and total fat body mass (p =0.02) increased. Group 1 patients had a significantly higher relative increase in REE (+7.1% ± 11.3% vs. +3.6% ± 15.1%, p = 0.02). There was no difference between the groups in the other variables. CONCLUSIONS Despite recent trends toward lowering the upper limit of normal TSH range, the results of this 12-month study provided no substantial clinical evidence to corroborate that treatment of primary hypothyroidism should aim at maintaining TSH levels in a low-normal range

Decrease in leptin production by the adipose tissue in obesity associated with severe metabolic syndrome.

OBJECTIVE To evaluate the associations between leptinemia and the components of metabolic syndrome (MetS). METHODS Fifty-one obese adults (9 men; 36.7 +/- 10.0 years; body mass index (BMI) 46.2 +/- 10.0 kg/m(2)) were submitted to clinical examination, determinations of body fat mass (BF, bioimpedance) and resting energy expenditure (REE, indirect calorimetry), and to hormonal and biochemical analysis. Patients were categorized into three groups, according to the number of criteria for MetS: Group I: none or 1; Group II: 2; and Group III: 3 or 4 criteria. RESULTS Absolute leptinemia (LepA; 37.5 +/- 16.9 ng/mL) was directly correlated with BMI (r = 0.48; p = 0.0004), waist circumference (r = 0.31; p = 0.028) and BF (r = 0.52; p = 0.0001). Leptinemia adjusted for BF (LepBF) was inversely correlated with weight (r = -0.41; p=0.027), REE (r = -0.34; p = 0.01) and number of MetS criteria (r = -0.32; p = 0.02). There was no difference in LepA among the groups. LepBF in Group III (0.58 +/- 0.27 ng/mL/kg) was significantly lower compared to Group I (0.81 +/- 0.22 ng/mL/kg; p = 0.03) and Group II (0.79 +/- 0.30 ng/mL/kg; p = 0.02). CONCLUSIONS Leptin production by the adipose tissue is decreased in obese subjects fulfilling three or more criteria of MetS, suggesting a state of relative leptin deficiency in obesity associated with advanced stages of MetS.

Insulin-Like Growth Factor-1, Leptin, Body Composition, and Clinical Status Interactions in Children with Cystic Fibrosis

Background/Aims: Children with cystic fibrosis (CF) are of increased risk of reduced fat body mass (FBM) and lean body mass (LBM). Serum concentrations of insulin-like growth factor-1 (IGF-1)and leptin could be markers of LBM and/or FBM depletion. To evaluate the relationships between disease activity, body composition, IGF-1and leptin concentrations in CF children. Methods: A cross-sectional study with 26 CF children aged 5.0–15.5 years and 33 healthy controls, mean age 9.4 years. Body composition was evaluated by dual-energy X-ray absorptiometry. Fasting blood samples were analyzed for leptin, IGF-1and IGFBP-3. Results: FBM standard deviation score (SDS; CF boys –0.02 ± 0.88 vs. 0.78 ± 0.65, p < 0.01; CF girls –0.37 ± 1.15 vs. 0.70 ± 0.97, p < 0.05), leptin concentration (CF boys 2.07 ± 0.79 vs. 3.07 ± 1.28 ng/ml, p < 0.05; CF girls 2.71 ± 0.86 vs. 5.00 ± 2.95 ng/ml, p < 0.05) and IGF-1SDS (CF boys –1.43 ± 1.50 vs. –0.32 ± 0.88, p < 0.05; CF girls –0.66 ± 1.66 vs. 0.64 ± 0.57, p < 0.01) were lower in CF children compared to controls. Shwachman score was the strongest predictor of lean body mass (R = 0.63). Leptin levels explain 60% of the variability in FBM. Conclusion: Serum concentrations of IGF-1 and leptin are decreased in children with CF and are associated with clinical conditions and body composition.

A comparative study of five centrally acting drugs on the pharmacological treatment of obesity

Context:No long-term studies have compared centrally acting drugs for treating obesity.Objective:To compare the efficacy and safety of diethylpropion (DEP), fenproporex (FEN), mazindol (MZD), fluoxetine (FXT) and sibutramine (SIB) in promoting weight loss.Design and Setting:A prospective, randomized, placebo (PCB)-controlled study conducted at a single academic institution.Patients:A total of 174 obese premenopausal women.Intervention:Participants randomly received DEP 75 mg (n=28), FEN 25 mg (n=29), MZD 2 mg (n=29), SIB 15 mg (n=30), FXT 20 mg (n=29) or PCB (n=29) daily over 52 weeks. Diet and physical activity were encouraged.Main Outcome Measures:The primary endpoints were changes in body weight and the proportion of women who achieved at least 5% weight loss by week 52 in the intent-to-treat population. Other measurements included anthropometry, safety, metabolic and cardiovascular parameters.Results:Weight loss was greater than PCB (−3.1±4.3 kg) with DEP (−10.0±6.4 kg; P<0.001), SIB (−9.5±5.9 kg; P<0.001), FEN (−7.8±6.9 kg; P<0.01) and MZD (−7.4±4.9 kg; P<0.01) but not with FXT (−2.5±4.1 kg). Ten (33.3%) women lost⩾5% of their initial weight with PCB, compared with 20 (71.4%; P<0.001) with DEP, 20 (69%; P<0.02) with FEN, 21 (72.4%; P<0.01) with MZD, 22 (73.3%; P<0.001) with SIB and 10 (35.5%) with FXT. Each medically treated group experienced more adverse events compared with PCB (P<0.001). Compared with PCB, constipation was more prevalent with DEP, SIB and MZD (P<0.01); anxiety was more prevalent with DEP (P=0.01); and irritability occurred more frequently with DEP and FEN (P=0.02). Significant improvements in the depression and anxiety scores, binge-eating episodes and quality of life correlated with weight loss.CONCLUSION:The centrally acting drugs DEP, FEN, MZD and SIB were more effective than PCB in promoting weight loss in obese premenopausal women, with a satisfactory benefit–risk profile.

Exercise-induced bronchospasm in obese adolescents.

BACKGROUND Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. METHODS A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10-16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n = 18); asthmatic non-obese (n = 21); obese non-asthmatic (n = 26); and healthy individuals (n = 15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV(1)) decreased > or = 15% in relation to pre-exercise FEV(1). Maximum percent fall in FEV(1) (MF%FEV(1)) and area above the curve (AAC(0-30)) were calculated to evaluate EIB severity and recovery. RESULTS No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV(1) and AAC(0-30) were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). CONCLUSIONS Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics.

Avaliação econômica do seguimento farmacoterapêutico em pacientes com diabetes melito tipo 2 em farmácias comunitárias

OBJECTIVE: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system. METHODS: In a prospective clinic study, 161 patients were divided into two groups, of which only one group received PF for 12 months. From the results, we calculated data of effectiveness and costs. The primary endpoint was the economic evaluation PF by using an indicator of effectiveness (changes in glycated hemoglobin), which was related to the costs of pharmaceutical care. Secondary endpoints were values of blood pressure, waist circumference and body mass index of patients, also related to costs of pharmaceutical care. RESULTS: A real reduction of 1.3% of HbA1 was observed in the PF group, in comparison to control group. The annual cost of the reduction in 1% in HbA1 values in the PF group patients was

Controle neuroendócrino do peso corporal: implicações na gênese da obesidade

45.15. This feature to improve the control of type 2 diabetic patients can be implemented with annual investments of about