Wagner Luiz do Prado

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.

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. The aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. In conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy.

BackgroundObesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents.MethodsSixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 ± 4.18 kg/m2) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Tukeys test as post-hoc and Students T test.ResultsLong-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05).ConclusionA long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos

O objetivo do presente estudo foi avaliar as alteracoes promovidas, por intervencao multidisciplinar, nas concentracoes plasmaticas de grelina e leptina, adiposidade visceral e prevalencia de esteatose hepatica nao alcoolica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m2) e 12 meninos (IMC 37,08 ± 3,17kg/m2), com idade entre 15 e 19 anos, quanto a concentracao de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnostico de NAFLD pelo metodo de ultra-sonografia. Os resultados demonstraram reducao significante na concentracao circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda reducao percentual na prevalencia de NAFLD, sendo este um resultado relevante, visto que esta doenca pode progredir para cirrose, tanto em criancas quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabolico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

Effects of 2 or 5 consecutive exercise days on adipocyte area and lipid parameters in Wistar rats

BackgroundExercise has been prescribed in the treatment and control of dyslipidemias and cholesterolemia, however, lipid responses to different training frequencies in hypercholesterolemic men have been inconsistent. We sought to verify if different frequencies of continuous moderate exercise (2 or 5 days/week, swimming) can, after 8 weeks, promote adaptations in adipocyte area and lipid parameters, as well as body weight and relative weight of tissues in normo and hypercholesterolemic adult male rats.MethodsNormal cholesterol chow diet or cholesterol-rich diet (1% cholesterol plus 0.25% cholic acid) were freely given during 8 weeks to the rats divided in 6 experimentals groups: sedentary normal cholesterol chow diet (C); sedentary cholesterol-rich diet (H); 5× per week continuous training normal cholesterol chow diet (TC5) and cholesterol-rich diet (TH5); 2× per week continuos traning normal cholesterol chow diet (TC2) and cholesterol-rich diet (TH2).ResultsNo changes were observed in lipid profile in normal cholesterol chow diet, but both 2 a 5 days/week exercise improved this profile in cholesterol-rich diet. Body weight gain was lower in exercised rats. Decrease in retroperitoneal and epididymal relative weights as well as reductions in adipocyte areas under all diets types were observed only in 5 days/week, while 2 days/week showed improvements mainly in cholesterol-rich diet rats.ConclusionOur results confirm the importance of exercise protocols to control dyslipidemias and obesity in rats. The effects of 5 days/week exercise were more pronounced compared with those of 2 consecutive days/week training.

Heart rate variability and its relationship with central and general obesity in obese normotensive adolescents

ABSTRACT Objective: To analyze the relationship between the heart rate variability parameters and the indicators of central and general obesity in obese normotensive adolescents. Methods: Seventy-four 13 to 18 year-old obese normotensive adolescents participated in this study. The indicators analyzed for central and general obesity were waist circumference and body mass index, respectively. Heart rate variability was obtained by heart rate monitoring. For this, the adolescents remained in a supine position for 7 minutes with controlled breathing. Parameters were obtained in time domain (standard deviation of all the RR intervals, root mean square of successive differences between the normal adjacent RR intervals and the percentage of adjacent intervals with more than 50ms) and frequency domain variables (low and high frequency bands and the sympathovagal balance). Results: After adjustments for gender, age, and cardiorespiratory fitness, a negative correlation between the waist circumference and the root mean square of successive differences between the normal adjacent RR intervals (ß=-1.51; standard error=0.56; p<0.05) and the percentage of adjacent intervals with more than 50 ms (ß=-0.96; standard error=0.34; p<0.05) were observed, while the body mass index showed no significant correlation with any heart rate variability parameter (p>0.05). Conclusion: Central obesity is a better discriminator than general obesity of autonomic cardiac dysfunction in obese normotensive adolescents

Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

OBJECTIVES To describe the effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. METHODS A total of 728 extremely obese adolescents, including 249 boys (aged 15.25+/-1.56 years) and 479 girls (aged 15.34+/-1.59 years) received multidisciplinary therapy during a period of 3 to 9 months. The therapy consisted of reduced energy intake, dietetic education, physical exercises and psychological therapy. Body composition was assessed by bioelectrical impedance analysis, and physical capacity was assessed by the multistage cycle ergometer test. Type and duration of each activity were recorded using a daily controlled activity diary. RESULTS There was a significant decrease (p < 0.05) in body mass (27.84+/-12.49 kg for boys and 21.60+/-9.87 kg for girls), body mass index (9.19+/-3.88 kg/m(2) for boys and 7.72+/-3.98 kg/m(2) for girls) and fat mass. In addition, the percentage of fat free mass increased significantly (p < 0.05) in boys (from 58.8+/-6.41 to 69.98+/-7.43%) and in girls (from 51.86+/-4.96 to 60.04+/-5.65%). CONCLUSIONS Long-term multidisciplinary approach allows significant reduction in severe obesity, preserving growth and percentage of fat free mass.

Obesidade e adipocinas inflamatórias: implicações práticas para a prescrição de exercício

A obesidade e uma doenca complexa de etiologia multifacetada, com sua propria fisiopatologia, comorbidades e capacidades desabilitantes. Aceitar a obesidade como uma doenca e fundamental para o seu tratamento. Atualmente, o tecido adiposo e um dos principais focos das pesquisas em obesidade, devido a uma revolucao no entendimento da funcao biologica desse tecido desde a ultima decada. Ja esta muito claro que o tecido adiposo branco secreta multiplos peptideos bioativos, denominados adipocinas (proteinas sintetizadas e secretadas pelo tecido adiposo). Dessa forma, o objetivo deste trabalho de revisao foi investigar a relacao entre obesidade e adipocinas inflamatorias, buscando discutir o papel do exercicio fisico no tratamento dessa patologia. Os resultados demonstram que uma das mais importantes descobertas das pesquisas recentes em obesidade e o conceito de que ela e caracterizada por uma inflamacao cronica. Dentre todas as adipocinas, sem duvida, a IL-6, o TNF-α, a leptina (pro-inflamatorias) e a adiponectina (anti-inflamatoria) vem recebendo atencao especial da literatura especializada. O aumento da concentracao dessas adipocinas promove grande impacto em diversas funcoes corporais que estao fortemente correlacionadas com doencas cardiovasculares. Uma vez que a obesidade e considerada uma doenca inflamatoria e o exercicio fisico modula de forma direta tais processos, e essencial que tenhamos como um dos objetivos principais de nossos programas de exercicios fisicos a melhora da resposta inflamatoria de obesos.

Physical fitness and academic performance in youth: A systematic review

Physical fitness (PF) is a construct of health‐ and skill‐related attributes which have been associated with academic performance (AP) in youth. This study aimed to review the scientific evidence on the association among components of PF and AP in children and adolescents. A systematic review of articles using databases PubMed/Medline, ERIC, LILACS, SciELO, and Web of Science was undertaken. Cross‐sectional and longitudinal studies examining the association between at least one component of PF and AP in children and adolescents, published between 1990 and June 2016, were included. Independent extraction of articles was carried out by the two authors using predefined data fields. From a total of 45 studies included, 25 report a positive association between components of PF with AP and 20 describe a single association between cardiorespiratory fitness (CRF) and AP. According to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines: 12 were classified as low, 32 as medium risk, and 1 as high risk of bias. Thirty‐one studies reported a positive association between AP and CRF, six studies with muscular strength, three studies with flexibility, and seven studies reported a positive association between clustered of PF components and AP. The magnitude of the associations is weak to moderate (β = 0.10–0.42 and odds = 1.01–4.14). There is strong evidence for a positive association between CRF and cluster of PF with AP in cross‐sectional studies; and evidence from longitudinal studies for a positive association between cluster of PF and AP; the relationship between muscular strength and flexibility with AP remains uncertain.

Perfil antropométrico e ingestão de macronutrientes em atletas profissionais brasileiros de futebol, de acordo com suas posições

The aim of this study was to evaluate the anthropometric profile, total energy value of the diet and macronutrient intake of professional soccer players, as well as verifying the differences among tactical positions: goalkeepers (n = 12), center backs (n = 20), median fields (n = 41), running backs (n = 21) and strikers (n = 24) in the studied variables. The sample was composed by 118 professional players (23 years ± 5 years) of the elite of the Sao Paulo state. All the evaluations were accomplished during the competitive period. Body composition was determined through skin folds measurement and the dietary data obtained through usual food intake. The goalkeepers and center backs were shown taller, heavier and with larger amount of lean mass than the other athletes, even so without significant differences among body fat percentage. The dietary habits of these athletes indicate a lower carbohydrate ingestion, hyperprotein and tendency to hyperlipidic diet. Thus, we can conclude that there are nutritional inadequacies and anthropometric differences among the players and their tactical positions. The results of the present study suggest that nutritional interventions are accomplished in the soccer elite, seeking to maximize the athletic performance.