RESUMO
BACKGROUND: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). AIM: To assess the results of this program. PATIENTS AND METHODS: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m(2) and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. RESULTS: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m(2) was observed in 69% and 52% of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24% and 6% respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28% and 9% respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61% and 19% respectively, a plasma insulin equal to or greater than 12,5 microUl/ml was observed in 49% and 34% respectively and a HOMA equal to or greater than 2.5 was observed in 63% and 42% respectively (all these comparisons are significant with a p <0.05). CONCLUSIONS: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels and HOMA index.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde , Obesidade/terapia , Adolescente , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Chile/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Recusa do Paciente ao TratamentoRESUMO
Background: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). Aim To assess the results of this program. Patients and methods: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m² and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. Results: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m² was observed in 69 percent and 52 percent of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24 percent and 6 percent respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28 percent and 9 percent respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61 percent and 19 percent respectively, a plasma insulin equal to or greater than 12,5 fi Ul/rnl was observed in 49 percent and 34 percent respectively and a HOMA equal to or greater than 2.5 was observed in 63 percent and 42 percent respectively (all these comparisons are significant with a p <0.05). Conclusions: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels...
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /prevenção & controle , Promoção da Saúde , Obesidade/terapia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Chile/epidemiologia , /complicações , /diagnóstico , Métodos Epidemiológicos , Obesidade/complicações , Obesidade/epidemiologia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Recusa do Paciente ao TratamentoRESUMO
BACKGROUND: The objective of this study was to evaluate changes in resting energy expenditure (REE), body composition and metabolic parameters, and to investigate predictors of the results in seriously obese patients after Roux-en-Y gastric bypass (RYGBP). METHODS: 31 patients (BMI 44.4 +/- 4.8 kg/m2; 27 female, 4 male; 37.3 +/- 11.1 y) were evaluated at baseline and 6 months after RYGBP. Weight, REE, waist circumference (WC), fat mass (FM) and fat-free mass (FFM), physical activity, food intake, fasting glucose (GLU), insulin (INS), HOMA-IR and lipid concentrations were measured. RESULTS: At 6 months, percentage of weight loss (%WL) was 29.0 +/- 4.4% and percentage of excess weight loss was (%EWL) 59.7 +/- 12.3%. FM loss corresponded to 77.1 +/- 12.2% of the weight loss. REE decreased from 33.4 +/- 4.1 to 30.1 +/- 2.6 kcal/kg FFM (P<0.05). Significant decreases (P<0.001) were observed in GLU, INS, HOMA-IR, LDL-cholesterol and triglycerides. %EWL was correlated with baseline INS (r=0.44; P=0.014), baseline HOMA (r=0.43; P=0.017), change in %FM (r=0.67; P<0.001) and change in WC (r=0.5; P<0.01). Decrease in REE/FFM (%) was positively correlated with baseline REE/FFM% (r=0.51; P<0.005) and change in %FM (r=0.69; P<0.001). Initial REE/FFM, baseline energy balance and FM change explain 90% of REE/FFM decrease. CONCLUSION: RYGBP was an effective procedure to induce significant weight loss, fat mass loss and improvement in metabolic parameters in the short term. Metabolic adaptation was not related to FFM wasting but to a higher baseline REE. Fasting hyperinsulinemia was the best single predictor of weight loss after RYGBP.