Ruth Rocha Franco

Síndrome metabólica em adolescentes com sobrepeso e obesidade

OBJECTIVE: Evaluate the prevalence of metabolic syndrome in adolescents followed in an outpatient obesity clinic. METHODS: 84 adolescents (ten to 19 years old) were divided in two groups, one composed by overweight adolescents (OWG) and the other, by obese adolescents (OBG), according to Z scores of the body mass index (Z BMI). OWG: Z BMI>1 and 2 (2.4±0.6; 32M/26F). Three or more criteria were considered to define the presence of metabolic syndrome and tested by chi-square: Z BMI>2; fasting triglycerides >130mg/dL; high-density lipoprotein cholesterol 100mg/dL or homeostatic model assessment index (HOMA) >2.5 and blood pressure above the 90th percentile, adjusted for age, gender and length. RESULTS: The prevalence of metabolic syndrome was significantly elevated in obese adolescents (OBG: 40% versus OWG: 4%, p=0.0008). The major differences between groups were observed regarding the presence in OBG adolescents of hyperinsulinism (54% versus 19%, p=0.003), HOMA (66% versus 38%, p=0.01) and hypertriglyceridemia (21% versus 4%, p=0.04). CONCLUSIONS: It is important to be aware of the early signs of metabolic syndrome in obese adolescents, which can be screened by simple techniques. As the syndrome correlates to chronic illnesses, early detection and adequate prevention by pediatricians is mandatory.

DBS for Obesity

Obesity is a chronic, progressive and prevalent disorder. Morbid obesity, in particular, is associated with numerous comorbidities and early mortality. In patients with morbid obesity, pharmacological and behavioral approaches often have limited results. Bariatric surgery is quite effective but is associated with operative failures and a non-negligible incidence of side effects. In the last decades, deep brain stimulation (DBS) has been investigated as a neurosurgical modality to treat various neuropsychiatric disorders. In this article we review the rationale for selecting different brain targets, surgical results and future perspectives for the use of DBS in medically refractory obesity.

O efeito da sibutramina na perda de peso de adolescentes obesos

Objective : To evaluate the effect of sibutramine on weight loss in obese adolescents.Subjetcs and methods A double-blind controlled study lasting 13 months. The study included 73 obese adolescents of both sexes aged between 10 and 18 years. Laboratory tests and imaging studies were performed before, during wash-out, and at the end of 13 months.Results : The percentage of patients who lost 10% of their initial weight in the placebo group was 46%, and in the sibutramine group was 75%. When placebo was used, average weight rose by 1.61 kg, and BMI decreased by 0.24 kg/m2 whereas with the use of sibutramine, weight decreased by 4.47 kg, and average BMI decreased, 2.38 kg/m2, with p < 0.001.Conclusions : Sibutramine induced significantly more weight loss in obese adolescents compared with placebo, without significant side effects. The weight loss curve was different depending on the moment sibutramine was introduced. This finding indicates that the best time to start sibutramine is when adhesion begins to fail. Arq Bras Endocrinol Metab. 2014;58(3):243-50

Polycystic Ovary Syndrome among Obese Adolescents

Abstract Background and aims: In adolescence and obesity, the pathophysiology of polycystic ovary syndrome (PCOS) is very difficult to distinguish. We aimed to assess the diagnosis of PCOS in the population of obese adolescent. Methods: Cross-sectional study. Setting: Pediatric Endocrinology Weight and Management Clinic from Childrens Institute, São Paulo, Brazil. Participants: Forty-nine post-menarcheal obese adolescents with mean age of 14.7 years. Interventions: Anthropometric assessment and review of medical records were done. Clinical and laboratory hyperandrogenism were quantified using Ferriman–Gallwey index and androgenic dosages, respectively. Ovarian morphology was evaluated through suprapubic ultrasonography. Results: By the 2015 Witchel et al. guideline for PCOS in adolescence, 18.4% were diagnosed as having PCOS. When assessed by Rotterdam, Androgen Excess and PCOS Society, and American National Institute of Health criterias, 26.4%, 22.4%, and 20.4% had PCOS, respectively. Irregular menstrual cycles were found in 65.3% of patients. Clinical hyperandrogenism was observed in 16.3% of girls and 18.4% had elevated serum androgen values. Suprapubic ultrasonography revealed enlarged ovaries in 18.4% of the adolescents. Conclusions: PCOS in all-comers obese adolescents from a Weight and Management Clinic in a quaternary hospital is more frequent when compared to adult women showed in the literature.

Lateral hypothalamic activity indicates hunger and satiety states in humans

Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader–Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food‐related cues induced an increase in beta/low‐gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alpha‐frequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.

SÍNDROME DE PRADER WILLI: O QUE O PEDIATRA GERAL DEVE FAZER - UMA REVISÃO

ABSTRACT Objective: To carry out a review about Prader-Willi Syndrome based on the most recent data about the subject and to give recommendation for the general pediatricians for early diagnoses and follow-up. Data sources: Scientific articles in the PubMed and SciELO databases. The research was not limited to a specific time period and included all articles in such databases. Data synthesis: The Prader-Willi Syndrome (PWS) is a rare genetic disorder resulting from the loss of imprinted gene expression within the paternal chromosome 15q11-q13. PWS is characterized by endocrine abnormalities, such as growth hormone (GH) deficiency, obesity, central adrenal insufficiency, hypothyroidism, hypogonadism and complex behavioral and intellectual difficulties. PWS individuals also may present other comorbidities, such as sleep disorders, scoliosis, constipation, dental issues and coagulation disorders. The follow-up protocol of the Children’s Institute at Universidade de São Paulo is based on four main pillars: diet, exercise, recombinant human growth hormone (rhGH) therapy and behavioral and cognitive issues. The diet must include a caloric restriction of 900 kcal/day, according to the Prader-Willi Eating Pyramid and exercise plan is focused on daily aerobic exercises and postural therapy. The rhGH therapy is highly recommended by the international scientific literature and must be started as soon as the diagnostic is made. The management of behavioral issues is based on strategies to establish routine and rules. Conclusions: If the general pediatrician becomes more familiar with PWS, the diagnosis and treatment will start earlier, which is essential to improve the quality of life and care for these individuals.

Obesity Prevention: Strategies and Challenges in Latin America

Purpose of ReviewThe purpose of this study is to present changes of policies and norms aimed to reduce obesity levels that have been adopted in some Latin American countries.Recent FindingsThe global increase of the excess weight within the population has been demanding governmental actions aimed at preventing health impacts generated by obesity. Over recent years, many Latin American countries have established a number of regulations aimed at reducing weight in the population using interventions that could effectively prevent childhood obesity, including the taxation of sugar-sweetened beverages (SSBs), increasing physical activity in open spaces, and, especially, front-of-package labeling.SummarySome strategies are part of the Action Plan for Prevention of Child and Adolescence Obesity signed by all countries in Latin America, which currently have among the highest prevalence of childhood obesity in the world. Among them are the implementation of fiscal policies on energy-dense and nutrient-poor foods and taxes on SSBs; improvements in nutrition labeling, highlighting the front-of-package (FOP) labeling to promote the choice of healthier products at the time of purchase; and promotion of an active lifestyle, such as encouraging the use of bicycle paths or physical activity programs at school. The real impact of these prevention strategies implemented in Latin America on the prevalence of obesity is still unknown.