Mitos y realidades sobre la obesidad en el síndrome de ovario poliquístico / Myths and realities about obesity in polycystic ovary syndrome

Introducción: La asociación entre la obesidad y el síndrome de ovario poliquístico es importante porque amplifica los trastornos metabólicos, reproductivos, psicológicos o de la calidad de vida. Sin embargo, es común que se sobrevalore o se emplee como criterio diagnóstico, lo que denota una definición no clara de esta relación. Objetivo: Analizar lo que, en opinión de los autores, pudieran ser "mitos" sobre la obesidad en el síndrome de ovario poliquístico y su coherencia con la evidencia disponible. Métodos: Se realizó una revisión del estado del arte en este tema. Se localizaron 230 artículos en las bases PubMed, Medline, Scielo y Google Académico, y se contrastó con los criterios propios. Conclusiones: Algunas creencias generalizadas sobre la obesidad en el síndrome de ovario poliquístico, aunque tienen cierto grado de certidumbre, se malinterpretan o magnifican, por lo que pueden considerarse "mitos". Entender que las mujeres con síndrome de ovario poliquístico pueden no tener obesidad y, aún así, tener adiposidad abdominal y los efectos que de ella derivan, no niega la evidencia indiscutible de que la obesidad, si está presente, agrava el síndrome. Polemizar sobre el tema pretende contribuir a que se diagnostique el síndrome no solo en mujeres con obesidad y que se considere factor de riesgo para la obesidad. Debe entenderse que la obesidad asociada al síndrome puede revertirse y que se pueden incorporar estilos de vida saludable y un control del peso corporal como pilares del tratamiento en todas las mujeres que padezcan este(AU)

Introduction: The association between obesity and polycystic ovary syndrome is important because it amplifies metabolic, reproductive, psychological, or quality of life disorders. However, it is commonly overestimated or used as a diagnostic criterion, which denotes an unclear definition of this relationship. Objective: To analyze what, in the authors' opinion, could be "myths" about obesity in polycystic ovary syndrome and their consistency with the available evidence. Methods: A state-of-the-art review on this subject was performed and contrasted with own criteria. Conclusions: Some widespread beliefs about obesity in polycystic ovary syndrome, although they have some degree of certainty, are misinterpreted or magnified, so they can be considered "myths". Understanding that the patients may not suffer from obesity and still have abdominal adiposity and the effects that derive from it, does not deny the indisputable evidence that, if present, it aggravates the syndrome. Discussing the subject intends to contribute to diagnose the syndrome not only in women with obesity. The aim is to consider it as a risk factor for obesity and to prevent it, to understand that obesity can be reversed, and to incorporate counseling on healthy lifestyles and body weight control as pillars of treatment in all women with the syndrome, with or without obesity(AU)

Waist-to-Height Ratio Percentiles and Cutoffs for Obesity: A Cross-sectional Study in Brazilian Adolescents.

This study aimed to describe the distribution of waist-to-height ratio (WHtR) percentiles and cutoffs for obesity in Brazilian adolescents. A cross-sectional study including adolescents aged 10 to 15 years was conducted in the city of São Paulo, Brazil; anthropometric measurements (weight, height, and waistcircumference) were taken, and WHtRs were calculated and then divided into percentiles derived by using Least Median of Squares (LMS) regression. The receiver operating characteristic (ROC) curve was used in determining cutoffs for obesity (BMI ≥97th percentile) and Mann-Whitney and Kruskal-Wallis tests were used for comparing variables. The study included 8,019 adolescents from 43 schools, of whom 54.5% were female, and 74.8% attended public schools. Boys had higher mean WHtR than girls (0.45±0.06 vs 0.44±0.05; p=0.002) and higher WHtR at the 95th percentile (0.56 vs 0.54; p<0.05). The WHtR cutoffs according to the WHO criteria ranged from 0.467 to 0.506 and 0.463 to 0.496 among girls and boys respectively, with high sensitivity (82.8-95%) and specificity (84-95.5%). The WHtR was significantly associated with body adiposity measured by BMI. Its age-specific percentiles and cutoffs may be used as additional surrogate markers of central obesity and its co-morbidities.

Association among sexual maturation, overweight and central adiposity in children and adolescents at two schools in São Paulo

The objective of this study was to assess the association among sexual maturation (SM), overweight and central adiposity in children and adolescents. A total of 617 children and adolescents age 8 to 18 years old participated in the longitudinal study. Three samples were collected including data on weight, height and waist circumference. Overweight was classi-fied based on critical values for body mass index (BMI) adopted for Brazilian children and teenagers. SM stage (SMS) was done by self-assessment in three children and adolescent samples. Participants were distributed in quartiles based on SMS and sex. Accelerated-maturing subjects were compared to others. Data was analyzed by linear regression and logistic regression. We found a negative association between BMI z-score and onset of SM in boys, whereas for girls relatively-accelerated SM was positively associated to overweight and values of BMI z-score. Relatively-accelerated maturing girls showed more central adi-posity. The research concluded that accelerated SM was associated to overweight and high-er increase in BMI for both sexes, highlighting the importance of identifying SMS in nutri-tional assessment for children and teenagers...

O objetivo foi analisar a associação entre maturação sexual relativamente acelerada, excesso de peso e adiposidade central em crianças e adolescentes. Foi realizado um estudo longitudinal com 617 crianças e adolescentes de 8 a 18 anos de idade. Foram realizadas três coletas de dados de peso, estatura, perímetro da cintura. O excesso de peso foi classificado com base nos valores críticos do índice de massa corporal (IMC) para crianças e adolescentes brasileiros. O estágio de maturação sexual (EMS) foi autoavaliado nas três coletas pelas crianças e adolescentes. Os indivíduos foram distribuídos em quartis de idades segundo EMS e sexo. Foram comparados os indivíduos com maturação relativamente acelerada com os demais indivíduos. Os dados foram analisados por meio de análises de regressão linear e logística. Foi observada associação negativa entre escore z do IMC e idade de início da maturação sexual em meninos, não sendo observada associação no sexo feminino. A maturação sexual relativamente acelerada associou-se positivamente com excesso de peso e com valores de escore z do IMC. Meninas com maturação relativamente acelerada apresentaram maior adiposidade central. A pesquisa concluiu que a maturação sexual acelerada associou-se com o excesso de peso e maior incremento no IMC em ambos os sexos evidenciando a importância da identificação do estágio de maturação sexual na avaliação nutricional de crianças e adolescentes...

Nível de atividade física para prevenção do excesso de gordura visceral em mulheres pós-menopáusicas: quanto é necessário? / Level of physical activity in the prevention of excess visceral fat in postmenopausal women: how much is needed?

OBJETIVO: Analisar a quantidade de atividade física (kcal/semana) necessária à prevenção do excesso de gordura visceral em mulheres pós-menopáusicas. SUJEITOS E MÉTODOS: A amostra incluiu 239 mulheres com uma idade média de 57,2 anos. A área de gordura visceral (AGV) foi medida por bioimpedância octopolar e a atividade física, com a versão longa do IPAQ. Foram construídas curvas Receiver Operating Characteristic (ROC) e considerado um intervalo de confiança de 95%. RESULTADOS: As áreas sob a curva ROC para a atividade física moderada e a caminhada revelaram-se significativas. O dispêndio semanal de 1.601 kcal na caminhada ou de 2.283 kcal de atividade física moderada foi identificado como bons valores de corte para prevenir o excesso de AGV. CONCLUSÃO: A prática da atividade física de intensidade leve a moderada, com um gasto calórico entre 1.601 e 2.283 kcal/semana, previne o excesso de adiposidade central em mulheres pós-menopáusicas.

OBJECTIVE: To analyze the level of physical activity (kcal/week) needed to prevent excess visceral fat in postmenopausal women. SUBJECTS AND METHODS: The sample included 239 women with a mean age of 57.2 years. Visceral fat area (VFA) was measured by octopolar bioelectrical impedance, and physical activity, by the long version IPAQ. ROC Curves (Receiver Operating Characteristic) were drawn, and a 95% confidence interval was used. RESULTS: The areas under the ROC curve for moderate physical activity and walk proved to be significant. Weekly expenditure of 1,601 kcal in walking, or 2,283 kcal in moderate physical activity were identified as good cutoff values to prevent excess VFA. CONCLUSION: Mild to moderate physical activity, with a caloric expenditure between 1,601 and 2,283 kcal/week, prevents excess central adiposity in postmenopausal women.

Dyslipidemias and obesity in Mexico

OBJECTIVE: To describe in a national sample 1) the mean total cholesterol (TC), HDL-cholesterol (HDLc) and triglyceride (TG) concentrations, 2) the prevalence of the most common lipid abnormalities and 3) the association between obesity and these conditions. MATERIAL AND METHODS: We analyzed the nationally representative, cross-sectional Me-xican Health Survey (2000). The final analytic sample used consisted of 2 351 individuals at fasting state. TC, HDLc and TG were determined. BMI was classified according to the WHO cut-off points. Sex-specific means and 95 percent confidence intervals (95 percentCI) were calculated by age group for TC, HDLc and TG. The prevalence of: a) hypercholesterolemia (HC), b) hypoalphalipoproteinemia (HA), c) hypertriglyceridemia (HT), d) HT with HA and e) HC with HT was calculated adjusting for age. Multivariate logistic regression models were estimated to analyze the association of obesity to the prevalence of dyslipidemias. RESULTS: The mean TC, HDLc, and TG concentrations were: 197.5 mg/dl (95 percent CI= 194.0, 201.1), 38.4 mg/dl (95 percent CI= 37.2, 39.5) and 181.7 mg/dl (95 percent CI= 172.7, 190.6), respectively. HC was present in 40.5 percent of the adult females (95 percent CI=35.5, 45.4) and 44.6 of the adult males (95 percent CI=37.7, 51.4); HA was the most prevalent form of dyslipidemia, present in 64.7 percent (95 percent CI=58.7, 70.8) and 61.4 percent (95 percent CI=54.4, 68.3) of females and males, respectively. Obesity increased ~1.4 times the probability ratio (PR) of having HC among women and 1.9 among men. CONCLUSION: TC concentrations from our study in Mexico were similar to those found for Mexican-Americans and the prevalence of HC was slightly lower than the one reported in the US; however, it increased ~26 percent from 1988 to 2000. HA was the most frequent lipid abnormality followed by HT. Regions showed no significant differences, contrary to what has been previously reported.

OBJETIVO: Describir en una muestra nacional las concentraciones de 1) colesterol total (CT), colesterol-HDL (cHDL) y triglicéridos, 2) la prevalencia de las anomalías lipídicas más comunes y 3) identificar la asociación entre obesidad y estas condiciones. MATERIAL Y MÉTODOS: Se analizó la Encuesta Nacional de Salud (2000), una encuesta representativa y transversal. La muestra analítica final consistió en 2 351 individuos en ayuno. Se determinaron las concentraciones de CT, cHDL y TG. El índice de masa corporal se clasificó de acuerdo con los puntos de corte de la OMS. Se calcularon las medias y el intervalo de confianza del 95 por ciento (IC95 por ciento) estratificado por sexo para CT, cHDL y TG. La prevalencia de a) hipercolesterolemia (HC), b) hipoalfalipoproteinemia (HA), c) hipertrigliceridemia (HT), d) HT con HA y e) HC con HT se calculó ajustando por edad. Se estimaron modelos de regresión logística mul-tivariada para analizar la asociación de la obesidad a la prevalencia de dislipidemias. RESULTADOS: Las medias de CT, cHDL y TG fueron: 197.5 mg/dl (IC95 por ciento= 194.0, 201.1), 38.4 mg/dl (IC95 por ciento= 37.2, 39.5) y 181.7 mg/dl (IC95 por ciento= 172.7, 190.6) respectivamente. La prevalencia de HC fue de 40.5 por ciento en mujeres (IC95 por ciento=35.5, 45.4) y 44.6 en hombres (IC95 por ciento=37.7, 51.4); HA fue la forma más prevalente de dislipidemia, presente en 64.7 por ciento (IC95 por ciento=58.7, 70.8) y 61.4 por ciento (IC95 por ciento=54.4, 68.3) de las mujeres y los hombres respectivamente. La obesidad aumentó ~1.4 veces la razón de probabilidad de tener HC en mujeres y 1.9 en hombres. CONCLUSION: Las concentraciones de CT de nuestro estudio fueron similares a las encontradas en mexicanos residentes en los EUA y la prevalencia de HC fue ligeramente menor que la reportada en dicho país; sin embargo aumentó ~26 por ciento de 1988 a 2000. Las HA fueron la anomalía lipídica más frecuente seguida de HT. Las regiones...