RESUMEN
OBJECTIVE: To understand the potential and limits of care for childhood obesity from the perspective of comprehensiveness, in the context of Primary Health Care, in Brazilian municipalities. METHODS: A qualitative approach was adopted, with an electronic form of a dissertative nature being applied in 11 municipalities in the five Brazilian regions, derived from the four axes of comprehensiveness defined by Ayres (needs, purposes, articulations, and interactions). RESULTS: Among the strengths for comprehensive care, the following were observed: the provision of services at different levels of care; the relevance of intersectoral programs in the development of actions aimed at the multidimensionality of childhood obesity; the implementation of strategies for systematizing care and tools that encourage the expansion of dialogue and humanization; and intersectoral coordination to create appropriate responses to the expanded needs of children and their families. Limitations include: the centralization of actions in nutrition professionals and in the care sphere; the failure to prioritize childhood obesity in health agendas; and the lack of trained professionals to deal with the complexity of obesity. CONCLUSIONS: The findings suggest that child obesity care practices, in order to be transformative, need to be understood in the context of comprehensiveness. And this includes (re)thinking public policies, professional practices, and the organization of work processes so that they are, in fact, more inclusive, participatory, dialogical, humanized, supportive, fair, and, therefore, effective.
Asunto(s)
Obesidad Infantil , Atención Primaria de Salud , Humanos , Brasil/epidemiología , Obesidad Infantil/terapia , Obesidad Infantil/prevención & control , Obesidad Infantil/epidemiología , Niño , Investigación Cualitativa , Atención Integral de Salud/organización & administración , CiudadesRESUMEN
In Mexico, 1 out of 3 schoolchildren aged 5 to 11 years is overweight or obese, which represents one of the main public health concerns, due to the fact that this condition in the child population is highly associated with the development of metabolic complications in adults. To date, dietary and physical activity interventions to prevent this problem have shown modest results worldwide. Biomedical studies in Mexico have shown that the pathophysiology of childhood overweight and obesity presents different molecular patterns, inflammation and oxidative stress, possibly associated with specific variants in the genome. However, the challenge is to achieve a secure characterization of this evidence so that it can be used in intervention studies aimed to improve the ability to predict and treat childhood overweight and obesity in Mexico. The biomedical challenge is to make knowledge a prevention strategy in families, in society and in the country, in order to fight the serious problem of obesity and its consequences.
En México 1 de cada 3 escolares de 5 a 11 años presenta sobrepeso u obesidad, lo cual representa una de las principales preocupaciones de salud pública, debido a que en la población infantil este padecimiento se asocia altamente con el desarrollo de complicaciones metabólicas en el adulto. Hasta el momento las intervenciones dietéticas y de actividad física para prevenir este problema han mostrado resultados modestos a nivel mundial. Los estudios biomédicos en México han demostrado que la fisiopatología del sobrepeso y la obesidad infantil presenta diferentes patrones moleculares, de inflamación y de estrés oxidativo, posiblemente asociados a variantes específicas en el genoma. Sin embargo, el reto es lograr la caracterización segura de estas evidencias para que sea posible emplearlas en los estudios de intervención encaminados a mejorar la capacidad de predicción y tratamiento del sobrepeso y la obesidad infantil en México. El reto biomédico es hacer del conocimiento una estrategia de prevención en las familias, en la sociedad y en el país, a fin de combatir el grave problema de la obesidad y sus consecuencias.
Asunto(s)
Obesidad Infantil , Humanos , México/epidemiología , Niño , Obesidad Infantil/terapia , Obesidad Infantil/prevención & control , Obesidad Infantil/epidemiología , Preescolar , Sobrepeso/epidemiología , Sobrepeso/terapiaRESUMEN
Introduction. Overweight adolescents are confronted daily with stereotypes that condition their body image, self-esteem, and mood. Objectives. To describe, in adolescents with overweight, the subjective experiences related to the body in daily life and their perceptions regarding the interventions and empathy of the health team. Population and methods. Descriptive study with qualitative approach. Semi-structured interviews were conducted with adolescents aged 11 to 18 years with selfreported mass index (BMI) ≥ 26 and referring to medical or nutritional follow-up for overweight, attended at the Adolescence Service of a hospital in the Autonomous City of Buenos Aires, between October 1, 2021, and May 31, 2022. Results. Twenty adolescents were evaluated, with a median age of 13.5 years, most of them from female sex (16/20). All reported body dissatisfaction from an early age (median age: 10 years old). They mention difficulty dressing due to the lack of different sizes; they even limit sports practice. They suffered weight- related body humiliation at school, in the family, or public (15/20). They perceived weight control in a dual way: weight loss was the primary stimulus for treatment, but its centrality in the consultations generated discomfort. The leading causes of therapeutic abandonment were the impossibility of temporarily sustaining the recommendations and the lack of weight loss. The treating team was willing to listen to the patients but needed to understand their daily experiences, physical, material, esthetic, social conditioning, beliefs, and perceptions. Conclusion. The adolescents included in this study perceived specific interventions of the healthcare team as beneficial, with empathic deficiencies.
Introducción. Adolescentes con exceso de peso confrontan a diario con estereotipos que condicionan su imagen corporal, autoestima y ánimo. Objetivos. Describir, en adolescentes con exceso de peso, las vivencias subjetivas relativas al cuerpo en la vida diaria y sus percepciones respecto a las intervenciones y empatía del equipo de salud. Población y métodos. Estudio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a adolescentes entre 11 y 18 años con índice de masa corporal (IMC) ≥ 26 autorreferenciado y/o que refirieran seguimiento médico o nutricional por exceso de peso, asistidos en el Servicio de Adolescencia de un hospital de la Ciudad Autónoma de Buenos Aires, entre el 1 de octubre de 2021 y el 31 de mayo de 2022. Resultados. Se evaluaron 20 adolescentes, con mediana de edad de 13,5 años, mayoritariamente de sexo femenino (16/20). La totalidad refirió insatisfacción corporal desde edades tempranas (edad mediana: 10 años). Mencionan dificultad para vestirse por falta de talles; limitan incluso la práctica deportiva. Padecieron humillación corporal relacionada con el peso en la escuela, la familia o la vía pública (15/20). Percibieron el control de peso de manera dual: su descenso fue el principal estímulo del tratamiento, pero su centralidad en las consultas generó malestar. Las principales causas de abandono terapéutico fueron la imposibilidad de sostener temporalmente las recomendaciones y la falta de descenso de peso. Se percibió del equipo tratante buena predisposición y escucha, pero cierta incomprensión sobre las vivencias cotidianas, condicionamientos físicos, materiales, estéticos, sociales, de sus creencias y percepciones. Conclusión. Percibieron beneficiosas ciertas intervenciones del equipo de salud, con falencias empáticas.
Asunto(s)
Imagen Corporal , Empatía , Sobrepeso , Humanos , Adolescente , Femenino , Masculino , Niño , Imagen Corporal/psicología , Sobrepeso/psicología , Sobrepeso/terapia , Autoimagen , Grupo de Atención al Paciente/organización & administración , Obesidad Infantil/psicología , Obesidad Infantil/terapiaRESUMEN
OBJECTIVE: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. METHODS: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. RESULTS: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R$1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. CONCLUSION: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.
Asunto(s)
Hospitales Pediátricos , Humanos , Adolescente , Niño , Brasil , Preescolar , Femenino , Masculino , Hospitales Pediátricos/economía , Hospitales Públicos/economía , Obesidad Infantil/terapia , Obesidad Infantil/economía , Atención Ambulatoria/economía , Costos de la Atención en Salud/estadística & datos numéricosRESUMEN
Our objective was to systematically examine the characteristics of exercise interventions on adherence and dropout in children and adolescents with obesity. PubMed, Embase, PsycINFO, Lilacs, Scielo, and The Cochrane Central Register of Controlled Trials and reference lists of relevant articles were searched. We included randomized controlled trials with exercise interventions for pediatric patients with obesity presenting data on dropout and/or adherence. Two reviewers screened the records independently for eligibility with disagreements being resolved by a third reviewer. Twenty-seven studies with 1268 participants were included. Because of high heterogeneity and poor reporting of adherence, it was not possible to perform a meta-analysis. Dropout prevalence was calculated, and subgroup analyses comparing different types of exercise and a meta-regression with potential moderators were performed. We found a dropout rate of 13%. Subgroup analyses did not identify significant differences. The duration of the exercise presented a moderating effect on dropout, suggesting that longer exercise sessions may lead to higher dropout in children and adolescents with obesity. Because of the poor adherence data, it is not clear which exercise characteristics may moderate adherence. To improve the quality of childhood obesity care, it is mandatory that future studies present adherence data. Systematic review registration: PROSPERO CRD42021290700.
Asunto(s)
Terapia por Ejercicio , Cooperación del Paciente , Pacientes Desistentes del Tratamiento , Obesidad Infantil , Ensayos Clínicos Controlados Aleatorios como Asunto , Adolescente , Niño , Humanos , Ejercicio Físico , Terapia por Ejercicio/métodos , Cooperación del Paciente/estadística & datos numéricos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Obesidad Infantil/terapia , Obesidad Infantil/psicologíaRESUMEN
Obesity is associated with inflammation and an increased risk of cardiovascular disease and premature mortality, as well as a range of other conditions. Obesity is a growing global problem, not only in adults, but also in children and adolescents. Therefore, the present study aimed to assess the effects of a one-year interdisciplinary intervention on the cardiometabolic and inflammatory profiles of adolescents with obesity. Twenty-two adolescents completed the intervention, which included clinical, nutritional, psychological and physical exercise counselling. Body composition, and metabolic, inflammatory, and cardiovascular risk biomarkers were analyzed before and after one year of intervention. Visceral and subcutaneous fat were determined ultrasonographically. The homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) equation were used to estimate insulin resistance and insulin sensitivity, respectively. A reduction in body mass, adiposity, glucose, and insulin and an improved lipid profile were observed after the therapy. Hyperleptinemia was reduced from 77.3% to 36.4%. Plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule 1 (ICAM-1), leptin, the leptin/adiponectin ratio, and the adiponectin/leptin ratio were also significantly improved. Metabolic changes were associated with a reduction in visceral fat and waist circumference, and adiponectin and the leptin/adiponectin ratio were associated with HOMA-IR. The interdisciplinary therapy promoted improvements in hyperleptinemia and metabolic, inflammatory, and cardiovascular biomarkers.
Asunto(s)
Enfermedades Cardiovasculares , Resistencia a la Insulina , Obesidad Infantil , Adulto , Adolescente , Niño , Humanos , Leptina , Enfermedades Cardiovasculares/etiología , Obesidad Infantil/terapia , Adiponectina , Factores de Riesgo , Índice de Masa Corporal , Inflamación/complicaciones , Biomarcadores , Factores de Riesgo de Enfermedad Cardiaca , Mediadores de InflamaciónRESUMEN
The COVID-19 lockdown caused health system issues, including the need for long-term care for patients with conditions like childhood obesity. We wanted to know how the lockdown had changed our patients' health and which variables had greater influence in preventing and managing overweight and obesity in kids and teens during and after the lockdown. METHODS: Our study comprised two phases. The initial descriptive cross-sectional phase included surveys of children who are overweight or obese and their parents/guardians from the Pediatric Obesity Clinic at the Child Welfare Unit (UBI, acronym in Spanish) in the Hospital General de México "Dr. Eduardo Liceaga" (n = 129). The participants were studied to explore changes in lifestyle, physical activity, sleep patterns, eating behaviors, food consumption, anxiety, and depression. In the second phase, the biochemical, body composition, and anthropometric parameters of 29 pre-COVID-19 patients were compared before and after the lockdown. RESULTS: The survey showed more moderate anxiety and depression, alterations in sleep, physical inactivity, and an increase in the consumption of animal products, fruits, cereals, tubers, sugary drinks, and ultra-processed food. In the study's comparative phase, we observed a substantial increase in BMI z-score (p = 0.01), waist circumference (p < 0.001), fat mass (p < 0.001), percentage of adiposity (p = 0.002), and basal glucose (p = 0.047) and a drop in lean mass (p = 0.008). CONCLUSIONS: The pandemic led to a loss of routines and socioeconomic changes that made it difficult to address weight and obesity in young people. The results show that managing obesity in our patients involves considering both lifestyle and the social environment. This encourages us to consider a comprehensive and personalized approach.
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COVID-19 , Obesidad Infantil , Animales , Humanos , Niño , Adolescente , Sobrepeso , Obesidad Infantil/epidemiología , Obesidad Infantil/terapia , Estudios Transversales , México/epidemiología , Índice de Masa Corporal , COVID-19/epidemiología , Control de Enfermedades TransmisiblesRESUMEN
This study is taken up to evaluate the effect of an exercise program on adolescents' obesity and overweight profile. For this purpose, a 1-group pretest-posttest study was conducted with 72 adolescents who underwent a physical activity program supervised by one health professional 5 times a week; the sessions were distributed over 12 weeks and lasted from 50 to 60 minutes. The primary outcomes were anthropometric measurements, whereas the secondary outcomes were lipid profile, blood glucose, and blood pressure. Outcomes were assessed before the intervention and 1 day after the program ended; significance was established at P < .05. As a result, a significant improvement was verified in all the primary outcomes (P< .001) and in most secondary outcomes (capillary blood glucose, P = .0001; triglycerides, P = .0001; and systolic blood pressure, P = .005). In conclusion, the supervised exercise program significantly reduced anthropometric measurements and blood glucose, triglycerides, and systolic blood pressure levels.
Asunto(s)
Sobrepeso , Obesidad Infantil , Adolescente , Humanos , Sobrepeso/terapia , Glucemia , Obesidad Infantil/terapia , Ejercicio Físico , Instituciones Académicas , Triglicéridos , Terapia por EjercicioRESUMEN
The COVID-19 pandemic reduced daily physical activity in the pediatric population, with deleterious effects on anthropometry, muscle function, aerobic capacity, and metabolic control. OBJECTIVE: Determine the changes in anthropometry, aerobic capacity, muscle function, and metabolic control of a 12-week concurrent training protocol in overweight and obese children and adolescents during the COVID-19 pandemic. PATIENTS AND METHOD: 24 patients participated and were divided into groups once a week (12S; n = 10) and twice a week (24S; n = 14). Anthropometry, muscle function, aerobic capacity, and metabolic biochemical tests were evaluated before and after the application of the concurrent training plan. Two-way ANOVA, Kruskal-Wallis test, and Fisher's post hoc test were used. RESULTS: Only the twice times week training improved the anthropometrics parameters (BMI - z, waist circumference and waist to height ratio). The muscle function tests (push up, standing broad jump and prone plank), improved in both groups such as the aerobic capacity measured by VO2maximo and the runned distance in Shuttle 20m run test. The HOMA index only improved with twice times week training without changes in lipid profile in both groups. CONCLUSIONS: The 12S and 24S groups improved aerobic capacity and muscular function. Only the 24S improved anthropometric parameters and the HOMA index.
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COVID-19 , Terapia por Ejercicio , Ejercicio Físico , Obesidad , Obesidad Infantil , Obesidad/terapia , Obesidad Infantil/terapia , COVID-19/epidemiología , COVID-19/psicología , Pandemias , Ejercicio Físico/fisiologíaRESUMEN
BACKGROUND: The action of atrial natriuretic peptide (ANP) on natriuresis, diuresis and vasodilatation, insulin resistance, liver, kidney, and adipose tissue may contribute to the healthy metabolic and cardiovascular development. Even though the circulating level of ANP is reduced in patients with obesity, its response to weight loss remains poorly explored in pediatric populations. OBJECTIVE: To evaluate the effects of ANP variations in response to interdisciplinary weight loss intervention on metabolic syndrome (MetS) and cardiometabolic risks in adolescents with obesity. METHODS: 73 adolescents with obesity attended a 20-week clinical interdisciplinary weight loss therapy including clinical, nutritional, psychological and exercise training approach. Body composition, biochemical analyses and blood pressure were evaluated. MetS was classified according to the International Diabetes Federation (IDF) (2007). After the treatment, volunteers were divided according to Increasing (n=31) or Decreasing (n=19) ANP plasma levels. RESULTS: Both groups present significant reduction of body weight, Body Mass Index (BMI), waist, neck and hip circumferences (WC, NC and HC, respectively) and increasing fat-free mass (FFM). Interestingly, a significant reduction in body fat, TG/HDL-c ratio and MetS prevalence (from 23% to 6%) was observed in the Increased ANP group only. CONCLUSION: This study suggests that an increase in ANP serum levels after weight loss therapy could be associated with improvements in cardiometabolic risks and the reduced prevalence of MetS in adolescents with obesity.
FUNDAMENTO: A ação do peptídeo natriurético atrial (ANP) na natriurese, diurese e vasodilatação, resistência à insulina, fígado, rim e tecido adiposo pode contribuir para o desenvolvimento metabólico e cardiovascular saudável. Embora o nível circulante de ANP seja reduzido em pacientes com obesidade, sua resposta à perda de peso ainda é pouco explorada em populações pediátricas. OBJETIVO: Avaliar os efeitos das variações do ANP em resposta à intervenção interdisciplinar para perda de peso na Síndrome Metabólica (SMet) e nos riscos cardiometabólicos em adolescentes com obesidade. MÉTODOS: 73 adolescentes com obesidade participaram de uma terapia interdisciplinar para perda de peso de 20 semanas, incluindo uma abordagem clínica, nutricional, psicológica e de exercícios físicos. A composição corporal, análises bioquímicas e pressão sanguínea foram avaliadas. A SMet foi classificada de acordo com a Federação Internacional de Diabetes (IDF) (2007). Após o tratamento, os voluntários foram divididos de acordo com os níveis de plasma do ANP aumento (n=31) ou ANP redução (n=19). RESULTADOS: Ambos os grupos apresentaram redução significativa de peso corporal, índice de massa corporal (IMC) e circunferências de cintura, pescoço e quadril (CC, CP e CQ, respectivamente), e aumento da massa livre de gordura (MLG). É interessante observar que houve uma redução significativa na gordura corporal, na razão de TG/HDL-c e na prevalência de SMet (de 23% para 6%) somente no grupo com ANP aumento. CONCLUSÃO: Este estudo sugere que o aumento nos níveis séricos de ANP após a terapia para perda de peso pode estar associado a melhorias nos riscos cardiometabólicos e na prevalência reduzida de SMet em adolescentes com obesidade.
Asunto(s)
Enfermedades Cardiovasculares , Síndrome Metabólico , Obesidad Infantil , Adolescente , Factor Natriurético Atrial/metabolismo , Composición Corporal , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Niño , Humanos , Síndrome Metabólico/epidemiología , Obesidad Infantil/terapia , Pérdida de Peso/fisiologíaRESUMEN
Resumo Fundamento Apesar da grande proporção de octogenários com embolia pulmonar aguda, há pouca informação indicando a estratégia de manejo ideal, especialmente medidas terapêuticas, como a terapia lítica. Objetivos O número de pacientes idosos diagnosticados com embolia pulmonar aguda aumenta constantemente. Porém, o papel do tratamento trombolítico não está claramente definido entre os octogenários. Nosso objetivo é avaliar a efetividade da terapia lítica em pacientes octogenários diagnosticados com embolia pulmonar. Métodos Cento e quarenta e oito indivíduos (70,3% de mulheres, n=104) com mais de 80 anos foram incluídos no estudo. Os pacientes foram divididos em dois grupos: tratamento trombolítico versus não-trombolítico. As taxas de mortalidade hospitalar e episódios de sangramento foram definidos como desfechos do estudo. Valor de p <0,05 foi considerado como estatisticamente significativo. Resultados A mortalidade hospitalar reduziu significativamente no grupo trombolítico em comparação ao não-trombolítico (10,5% vs. 24,2%; p=0,03). Episódios de sangramento menores foram mais comuns no braço que recebeu o tratamento trombolítico, mas grandes hemorragias não diferiram entre os grupos (35,1% vs. 13,2%, p<0,01; 7% vs. 5,5% p=0,71, respectivamente). O escore de PESI alto (OR: 1,03 IC95%; 1,01-1,04 p<0,01), a terapia trombolítica (OR: 0,15 IC95%; 0,01-0,25, p< 0,01) e níveis altos de troponina (OR: 1,20 IC95%; 1,01-1,43, p=0,03) estiveram independentemente associados a taxas de mortalidade hospitalar na análise de regressão multivariada. Conclusão A terapia trombolítica esteve associada à mortalidade hospitalar reduzida em detrimento do aumento geral das complicações de sangramento em octogenários.
Abstract Background Despite the high proportion of octogenarians with acute pulmonary embolism, there is little information indicating the optimal management strategy, mainly therapeutic measures, such as lytic therapy. Objectives The number of elderly patients diagnosed with acute pulmonary embolism increases constantly. However, the role of thrombolytic treatment is not clearly defined among octogenarians. Our objective is to evaluate the effectiveness of lytic therapy in octogenarian patients diagnosed with pulmonary embolism. Methods One hundred and forty eight subjects (70.3% women, n=104) aged more than eighty years were included in the study. The patients were divided in two groups: thrombolytic versus non-thrombolytic treatment. In-hospital mortality rates and bleeding events were defined as study outcomes. P-value <0.05 was considered as statistical significance. Results In-hospital mortality decreased significantly in the thrombolytic group compared to the non-thrombolytic group (10.5% vs. 24.2% p=0.03). Minor bleeding events were more common in the arm that received thrombolytic treatment, but major hemorrhage did not differ between the groups (35.1% vs. 13.2%, p<0.01; 7% vs. 5.5% p=0.71, respectively). High PESI score (OR: 1.03 95%CI; 1.01-1.04 p<0.01), thrombolytic therapy (OR: 0.15 95%CI; 0.01-0.25, p< 0.01) and high troponin levels (OR: 1.20 95%CI; 1.01-1.43, p=0.03) were independently associated with in-hospital mortality rates in the multivariate regression analysis. Conclusion Thrombolytic therapy was associated with reduced in-hospital mortality at the expense of increased overall bleeding complications in octogenarians.
Asunto(s)
Humanos , Niño , Adolescente , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/epidemiología , Obesidad Infantil/terapia , Composición Corporal , Pérdida de Peso/fisiología , Índice de Masa Corporal , Factor Natriurético Atrial/metabolismoRESUMEN
Resumo Fundamento A ação do peptídeo natriurético atrial (ANP) na natriurese, diurese e vasodilatação, resistência à insulina, fígado, rim e tecido adiposo pode contribuir para o desenvolvimento metabólico e cardiovascular saudável. Embora o nível circulante de ANP seja reduzido em pacientes com obesidade, sua resposta à perda de peso ainda é pouco explorada em populações pediátricas. Objetivo Avaliar os efeitos das variações do ANP em resposta à intervenção interdisciplinar para perda de peso na Síndrome Metabólica (SMet) e nos riscos cardiometabólicos em adolescentes com obesidade. Métodos 73 adolescentes com obesidade participaram de uma terapia interdisciplinar para perda de peso de 20 semanas, incluindo uma abordagem clínica, nutricional, psicológica e de exercícios físicos. A composição corporal, análises bioquímicas e pressão sanguínea foram avaliadas. A SMet foi classificada de acordo com a Federação Internacional de Diabetes (IDF) (2007). Após o tratamento, os voluntários foram divididos de acordo com os níveis de plasma do ANP aumento (n=31) ou ANP redução (n=19). Resultados Ambos os grupos apresentaram redução significativa de peso corporal, índice de massa corporal (IMC) e circunferências de cintura, pescoço e quadril (CC, CP e CQ, respectivamente), e aumento da massa livre de gordura (MLG). É interessante observar que houve uma redução significativa na gordura corporal, na razão de TG/HDL-c e na prevalência de SMet (de 23% para 6%) somente no grupo com ANP aumento. Conclusão Este estudo sugere que o aumento nos níveis séricos de ANP após a terapia para perda de peso pode estar associado a melhorias nos riscos cardiometabólicos e na prevalência reduzida de SMet em adolescentes com obesidade.
Abstract Background The action of atrial natriuretic peptide (ANP) on natriuresis, diuresis and vasodilatation, insulin resistance, liver, kidney, and adipose tissue may contribute to the healthy metabolic and cardiovascular development. Even though the circulating level of ANP is reduced in patients with obesity, its response to weight loss remains poorly explored in pediatric populations. Objective To evaluate the effects of ANP variations in response to interdisciplinary weight loss intervention on metabolic syndrome (MetS) and cardiometabolic risks in adolescents with obesity. Methods 73 adolescents with obesity attended a 20-week clinical interdisciplinary weight loss therapy including clinical, nutritional, psychological and exercise training approach. Body composition, biochemical analyses and blood pressure were evaluated. MetS was classified according to the International Diabetes Federation (IDF) (2007). After the treatment, volunteers were divided according to Increasing (n=31) or Decreasing (n=19) ANP plasma levels. Results Both groups present significant reduction of body weight, Body Mass Index (BMI), waist, neck and hip circumferences (WC, NC and HC, respectively) and increasing fat-free mass (FFM). Interestingly, a significant reduction in body fat, TG/HDL-c ratio and MetS prevalence (from 23% to 6%) was observed in the Increased ANP group only. Conclusion This study suggests that an increase in ANP serum levels after weight loss therapy could be associated with improvements in cardiometabolic risks and the reduced prevalence of MetS in adolescents with obesity.
Asunto(s)
Humanos , Niño , Adolescente , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/epidemiología , Obesidad Infantil/terapia , Composición Corporal , Pérdida de Peso/fisiología , Índice de Masa Corporal , Factor Natriurético Atrial/metabolismoRESUMEN
OBJECTIVE: To determine the changes in a planned concurrent exercise protocol in overweight and obese children and adolescents who attend a cardiometabolic rehabilitation program at the Dr. Exequiel González Cortés hospital. PATIENTS AND METHOD: 32 patients were divided into two groups, the intervention group (INT) (n = 22; age: 12.9 ± 2.7), and the control group (CON) (n = 10; age: 12.6 ± 2.5). The INT performed 12 weeks of periodized concurrent training protocol, those who voluntarily left the program made up the CON. The measurements were made on three consecutive days; day 1: pre-participation cardiovascular evaluation and anthropometry, day 2: aerobic capacity and muscle function, and day 3: lipid profile and glycemic control. RESULTS: The INT presented a decrease in the body mass index (BMI) (-0.77 ± 1.02 kilogram/meter2; P=0.001), BMI z-score (-0.14 ± 0.20 Standard Deviation; P=0.002), waist circumference (-5.48 ± 6.42 centimeters; P = 0.0004), and waist to height ratio (-0.04 ± 0.04; P < 0.0001). Maximal oxygen consumption (2.24 ± 2.15 milliliters/kilogram/ minutes; P < 0.0001) and walked distance (104.55 ± 119.35 meters; P < 0.0001) improved in the INT. The push-ups 6.00 repetitions interquartile range (IQR) (4.00 - 11.00; P = 0.0001), standing broad jump 16.00 centimeters IQR (8.00 - 21.25; P = 0.004), and prone plank 56,00 seconds IQR (38.00 - 73.00; P < 0.0001), improved in the INT, in addition to presenting a decrease in total cholesterol -11.00 milligram/deciliters IQR (-18.50 - 3.50; P = 0.02). Glycemic control did not change between both groups. CONCLUSIONS: A 12-week planned concurrent exercise protocol of twelve weeks is effective to improve anthropometry, aerobic capacity, muscle function, and total cholesterol in overweight and obese children and adolescents.
Asunto(s)
Sobrepeso , Obesidad Infantil , Humanos , Niño , Adolescente , Sobrepeso/terapia , Obesidad Infantil/terapia , Ejercicio Físico , Terapia por Ejercicio , ColesterolRESUMEN
OBJECTIVE: To investigate the relationship between in utero growth conditions, as indicated by neonatal anthropometric measures, and childhood obesity treatment response, to examine the potential usefulness of neonatal anthropometrics as a potential childhood obesity treatment stratification tool. STUDY DESIGN: The study included 2474 children and adolescents with obesity (mean age, 11.2 years; range, 5.0-18.9 years) treated at the Children's Obesity Clinic in Holbæk, Denmark. Treatment response was registered prospectively, and neonatal data were collected from national electronic registers. RESULTS: Birth weight, birth length, birth weight for gestational age, and large for gestational age status were positively associated with the degree of obesity at treatment initiation. After a mean (SD) of 1.27 (0.69) years of enrollment in obesity treatment, the children exhibited a mean reduction of -0.32 (0.50) in body mass index SD score. No significant associations between neonatal anthropometric measures and childhood obesity treatment response were detected. CONCLUSIONS: Neonatal anthropometric measures were positively associated with the degree of obesity at treatment initiation but not with response to multidisciplinary treatment of childhood obesity. Individualization of obesity treatment based on neonatal anthropometry does not seem warranted.
Asunto(s)
Obesidad Infantil , Adolescente , Antropometría , Peso al Nacer , Índice de Masa Corporal , Niño , Edad Gestacional , Humanos , Recién Nacido , Obesidad Infantil/complicaciones , Obesidad Infantil/terapiaRESUMEN
Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short- and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.
Asunto(s)
Diabetes Mellitus Tipo 2 , Obesidad Infantil , Adolescente , Dieta , Ejercicio Físico , Humanos , Estilo de Vida , Obesidad Infantil/epidemiología , Obesidad Infantil/terapiaRESUMEN
Obesity is the most important predisposing factor for cardiovascular disease and type-2 diabetes. We explored the relationship between the age at onset of obesity and selected cardiometabolic parameters in young adults. Longitudinal study of n = 1,039 participants (48% males) in their early twenties. BMI was measured at birth, 1-5-10-12-14-16-23 years. BMI trajectories were interpolated. Five groups were identified: never obese (never-OB); early childhood obesity transitioning to non-obesity before adolescence (former-OB); obesity starting in preadolescence transitioning to non-obesity as adolescents (transient-OB); obesity from adolescence into early adulthood (recent-onset-OB); participants who were obese in early childhood and remained obese into adulthood (persistent-OB). Waist circumference (WC), blood pressure, lipids, glucose, and insulin were measured at 23 years. HOMA-IR and the Metabolic Syndrome Risk Z-Score were estimated. In the sample, 47% were obese during at least one time-point. Mean obesity duration was 20.7 years, 8.5 years, 6.2 years, and 3.3 years in persistent-OBs, recent-onset-OBs, former-OBs, and transient-OBs, respectively. The cardiometabolic profile was more adverse in recent-onset-OBs (12%) and persistent-OBs (15%) compared to never-OB participants (53%). Although former-OBs (15%) and transient-OBs (4%) had higher WC values than never-OBs, no differences were seen in other biomarkers. Both persistent and recent-onset obesity led to a cardiometabolic profile of risk in early adulthood, as suggested by values of WC, HOMA-IR, and hs-CRP above normal limits and HDL-chol values below normal limits. Participants who had obesity in early childhood or preadolescence but transitioned to a non-obesity status had a cardiometabolic profile similar to participants who were never obese and within normal limits. Obesity leads to risky values in a number of cardiometabolic biomarkers in young adulthood independent of age at obesity onset. Likewise, overcoming obesity during the pediatric age leads to a cardiometabolic profile within normal ranges at 23 years of age.
Asunto(s)
Factores de Riesgo Cardiometabólico , Enfermedades Cardiovasculares/prevención & control , Síndrome Metabólico/prevención & control , Obesidad Infantil/terapia , Adolescente , Edad de Inicio , Índice de Masa Corporal , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Resistencia a la Insulina , Estudios Longitudinales , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Síndrome Metabólico/etiología , Obesidad Infantil/complicaciones , Obesidad Infantil/diagnóstico , Obesidad Infantil/metabolismo , Estudios Prospectivos , Valores de Referencia , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short- and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.
Asunto(s)
Humanos , Adolescente , Diabetes Mellitus Tipo 2 , Obesidad Infantil/terapia , Obesidad Infantil/epidemiología , Ejercicio Físico , Dieta , Estilo de VidaRESUMEN
Physical training is recommended for obese paediatric populations. We investigated the effects of recreational judo training (JT) upon body composition and distribution, cardiorespiratory fitness, and heart rate variability (HRV) in overweight or obese children. A controlled trial (RBR-9d94td) was conducted with 35 children (8-13 years) assigned into groups according to their body mass index (BMI): eutrophic (EU; n = 15; z-BMI ≤ +l and ≥ -2) and overweight or obese (OB; n = 20; z-BMI > +1 and ≤ +3). The 12-week JT included 60-min sessions performed 2 times/week at 65-75% maximal heart rate (HR). BMI, waist circumference, blood pressure, HRV, peak oxygen uptake (VO2peak), gas exchange threshold (GET), and body fractioning were assessed. Significant reductions in OB (P < 0.05) occurred for whole body and trunk fat (~3%), trunk/limb fat-ratio (~4%), resting HR (~3%), and sympathovagal balance (log LF:HF, ~85%). Increases (P < 0.05) occurred in lean mass (~8%), parasympathetic modulation (log HF, ~4%), VO2peak (~5-10%), and VO2 (~15%), speed (~10%) and slope (~13%) at GET. Markers of cardiorespiratory fitness (relative VO2, slope and speed at GET) in OB approached EU after JT. In conclusion, a relatively short JT intervention to improved body composition, autonomic modulation, and physical fitness in obese children.