Vagus nerve stimulation: a novel method for obesity treatment? / 中华内分泌代谢杂志

Obesity is one of the most serious global public health issue. In addition to advocating healthy lifestyle, scientists are devoted to developing healthy and effective ways to tackle obesity. In recent years, vagus nerve stimulation has been revealed to have potential therapeutic effect on obesity, which may be related to regulating endocrine hormones and body metabolism, affecting different nerve functions, regulating inflammatory and immune pathways, adjusting intestinal flora and circadian rhythm, and so on. Current researches focus on percutaneous stimulation(auricular vagus nerve stimulation), subcutaneous stimulation(cervical and abdominal vagus nerve stimulation), and gastrointestinal stimulation(the implantation of vagus nerve stimulation device and vagus nerve blocking device). Growing number of studies have confirmed that these stimulation methods have favorable effects on obesity with less side effects. Moreover, the mechanism of Chinese traditional acupuncture for obesity treatment is similar to that of vagus nerve stimulation. Most of vagus nerve stimulation is conveyed via physical therapy. It is highly feasible and theoretically has few side effects, therefore is easy to be accepted by obese subjects and may become a promising approach for obesity treatment.

Cirugía bariátrica en adolescentes con obesidad severa: recomendaciones de la Rama de Nutrición, Sociedad Chilena de Pediatría / Bariatric surgery in adolescents with severe obesity: recommendations of the Nutrition Branch, Chilean Pediatric Society

Resumen: En los últimos años, la obesidad severa en adolescentes ha aumentado a nivel mundial y Chile no es la excepción a este fenómeno. Es conocido que esta condición aumenta exponencialmente los riesgos para la salud y se asocia a mortalidad prematura. Desde el año 2008, diversas guías de tratamiento de obesidad pediátrica han incluido a la cirugía bariátrica como una estrategia de tratamiento para adolescentes obesos severos seleccionados. Estos procedimientos han mostrado ser seguros y eficaces en adultos. Un cuerpo emergente de evidencia demuestra que, en centros especializados, en el corto y mediano plazo se obtendrían resultados similares en adolescentes. Sin embargo, en este grupo de pacientes, la cirugía bariátrica tiene implícitos otros riesgos inherentes a la etapa de desarrollo en que se encuentran, y los resultados y complicaciones especialmente de largo plazo en gran medida son aún desconocidos. Por lo anterior y para el logro de los resultados esperados, es muy importante que la selección de pacientes, la cirugía y el seguimiento, sean realizados por equipos multidisciplinarios calificados, en centros hospitalarios que cuenten con la infraestructura adecuada, siendo imprescin dible la adherencia de por vida al seguimiento médico y nutricional. El objetivo de este documento es presentar la postura de la Rama de Nutrición de la Sociedad Chilena de Pediatría (SOCHIPE) frente a las diversas aristas a considerar para la adecuada indicación de estos procedimientos en adolescentes obesos severos.

Abstract: In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

Cirugía bariátrica en adolescentes / Bariatric surgery in adolescents

Resumen: La epidemia de obesidad afecta en forma transversal a todo el ciclo vital. En particular, en las últimas décadas se ha observado un incremento de la obesidad severa en adolescentes. En esta etapa de la vida caracterizada por profundos cambios físicos, emocionales y gran vulnerabilidad, la obesidad severa tiene pocas opciones efectivas de tratamiento. En adolescentes, los resultados del tratamiento centrado en modificaciones del estilo de vida son modestos y el arsenal farmacológico muy acotado y de poca efectividad. La Cirugía Bariátrica (CB) ha surgido como una opción terapéutica viable para un grupo seleccionado de adolescentes. El objetivo de esta revisión es presentar una visión actualizada respecto a indicaciones, contraindicaciones, complicaciones y resultados de estos procedimientos en población adolescente.

Abstract: The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

Recomendaciones de padres de niños obesos en tratamiento para el equipo de salud: estudio cualitativo / Recommendations from parents of obese children in treatment to the health-care team: qualitative study

Introducción: La familia tiene un rol fundamental en la adherencia y efectividad del tratamiento de la obesidad infantil; conocer la experiencia de los cuidadores es una herramienta valiosa a considerar. Objetivo: Describir las recomendaciones para el equipo de salud que efectúan los padres cuidadores de niños(as) en tratamiento por obesidad. Pacientes y Método: Estudio transversal, descriptivo, con enfoque cualitativo y muestreo intencionado. En el primer semestre del año 2015 se entrevistó a nueve padres de niños de 4 a 10 años de edad, en tratamiento por su obesidad y con al menos tres controles durante el año previo. El análisis de datos se basó en los planteamientos de la Grounded Theory, mediante codificación abierta. El estudio tuvo aprobación ética y se utilizó consentimiento informado. Resultados: Los datos fueron agrupados en cinco categorías principales: a) Relación equipo de salud-cuidador, b) Relación equipo de salud-niño(a), c) Promover la participación familiar, d) Motivar adherencia terapéutica en el niño(a) y e) Frecuencia de controles. Conclusiones: Desde la perspectiva de este grupo de padres de niños con obesidad, el rol del equipo de salud debe basarse en establecer un vínculo terapéutico cercano con los niños(as) y sus padres durante el proceso de tratamiento, además de promover la participación del grupo familiar. Se destaca la importancia de desarrollar intervenciones terapéuticas que consideren la perspectiva del sistema consultante.

Introduction: The family plays an essential role in the adherence and effectiveness in the treatment of childhood obesity. Caregivers’ experience is fundamental for proper guidance. Aim: To describe the recommendations for the health-care team made by parents of children that are being treated for obesity. Patients and Method: Cross-sectional and descriptive study with a qualitative approach and purposeful sampling. In the first semester of 2015, interviews were conducted with nine parents of children from 4 to 10 years old that were being treated for obesity ad who had at least three medical appointments in the previous year. The data analysis was based on the Grounded Theory Approach through open coding. The study was ethically approved and informed parental consent was obtained. Results: The results were grouped in the following main categories: a) Health-care team-caregiver relationship, b) Health-care team-child relationship, c) Encouraging family participation, d) Encouraging therapeutic adherence in the child and e) Frequency of medical appointments. Conclusion: From the perspective of this group of parents of obese children, the health-care team should establish a close therapeutic bond with the children and their parents during the treatment process, in addition to encouraging family participation. The importance of developing therapeutic interventions that consider the perspective of the patient’s system is emphasized.

Algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia / Some aspects of interest about bariatric surgery applied in childhood and adolescence

Antecedentes: un porcentaje significativo de los niños y adolescentes afectados por la obesidad desarrollarán obesidad mórbida en algún momento de su vida adulta. Actualmente, el empleo de la cirugía bariátrica en estos pacientes es un tema polémico, por lo que resulta de interés conocer sus aspectos más relevantes, así como sus resultados en esta etapa de la vida. Objetivo: describir algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia. Desarrollo: se exponen y comentan los principales riesgos asociados a la obesidad en la niñez y adolescencia, los objetivos del tratamiento y los criterios de inclusión en un programa de cirugía bariátrica. Se enfatiza en el tiempo de tratamiento previo para valorar la necesidad de la intervención, la edad, el índice de masa corporal, la madurez sexual, ósea y psicológica del paciente, entre otros criterios, para autorizarla. También, se describen las contraindicaciones y medidas preoperatorias, ya que su conocimiento y cumplimiento posibilitarían la obtención de los resultados esperados. Se hace mención de las vías y técnicas quirúrgicas empleadas, así como algunos de sus resultados y complicaciones. Consideraciones finales: se exponen algunos aspectos de interés sobre cirugía bariátrica en la infancia y la adolescencia, con hincapié en los elementos más controversiales, lo que permite seleccionar a los pacientes que mejor evolución puedan tener con este tipo de intervención(AU)

Background: a significant percentage of obese children and adolescents develop morbid obesity at some time of their adulthood. The use of bariatric surgery in these patients is a controversial issue at present, so it is interesting to find out its most relevant aspects and results in this stage of life. Objective: to describe some aspects of interest on bariatric surgery applied in childhood and adolescence. Development: this review sets forth and comments on the main risks associated to obesity in childhood and adolescence, the objectives of the treatment and the inclusion criteria to be met in a bariatric surgery program. Emphasis was made on length of previous treatment to assess the need for intervention, age, body mass index, sexual, bone and psychological maturity of the patient, among other criteria, for giving authorization. Counterindications and preoperative measures were also described since knowing and complying with them would facilitate the expected results. Mention was made to the surgical paths and techniques as well as some results and complications of the bariatric surgery. Final thoughts: some aspects of interest on bariatric surgery in childhood and adolescence were explained, with emphasis on the most controversial elements, which will allow selecting the patients that could present better evolution with this type of intervention(AU)

Cross-sectional study of the dispensation of synthetic anorectic drugs in community pharmacies in the city of Cruz Alta - State of Rio Grande do Sul

Obesity is defined as the excess adipose tissue in the body. Drugs responsible for inhibiting the appetite are called anorectics or appetite suppressants. Sibutramine, fenproporex and amfepramone belongs to this class, and are capable of causing physical or psychological dependence. The aim of this study was to evaluate the frequency of prescriptions for appetite suppressants in community pharmacies at Cruz Alta, State of Rio Grande do Sul, Brazil. The sales of fenproporex, amfepramone and sibutramine in the months of September, October and November 2010 and April, May and June 2011 were compared. It was observed that the most commonly dispensed anorectic in the three community pharmacies analyzed was sibutramine. In the months of September, October and November 2010, consumption was higher, with sibutramine achieving 40.3% of overall sales, amfepramone 21% and, finally, fenproporex, 7.9%. The consumption of appetite suppressants was more prevalent in females, who represented 82% of total. The results suggested the existence of high consumption of anorectics, possibly related to the current concern with aesthetic standards, which emphasizes the importance of strict control over the marketing of these substances.

Obesidade define-se como excesso de tecido adiposo no organismo. Os fármacos responsáveis por inibir o apetite são denominados anorexígenos ou supressores de apetite. Sibutramina, femproporex e anfepramona, pertencentes a essa classe, são capazes de provocar dependência física ou psíquica. O objetivo deste estudo foi avaliar a prevalência da prescrição de anorexígenos em farmácias comerciais de Cruz Alta - RS. Foi comparada a venda dos fármacos femproporex, anfepramona e sibutramina, nos meses de setembro, outubro e novembro de 2010 e abril, maio e junho de 2011. Observou-se que o anorexígeno mais prescrito nas três farmácias analisadas foi a sibutramina. Nos meses de setembro, outubro e novembro de 2010, o consumo foi maior, quando a sibutramina alcançou um percentual de 40,3%, a anfepramona 21% e, por fim, o femproporex, 7,9%. O consumo de inibidores de apetite foi mais prevalente no sexo feminino, o qual representou 82% do total. Os resultados sugeriram a existência de elevado consumo de anorexígenos, possivelmente relacionada à preocupação com padrões estéticos atuais, o que ressalta a importância de um controle rigoroso sobre a comercialização destas substâncias.

Early dropout predictive factors in obesity treatment

Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.

Programa MINSAL-FONASA para Tratamiento de la Obesidad Infanto-Juvenil / MINSAL-FONASA Pilot Study in obese children and adolescents

La disminución de la obesidad es un objetivo sanitario para la década. Objetivo: Evaluar respuesta antropométrica, metabólica y adherencia a corto plazo, a un modelo de intervención en obesidad infantil. Sujetos y Método: Niños(as) obesos, 6-19 años, ingresados a un programa piloto; intervención multidisciplinaria, de 4 meses de duración. Se evaluó al ingreso y 4 meses 1MC, perímetro de cintura (PC), lípidos plasmáticos, glicemia e insulinemia. Resultados: Ingresaron 402 pacientes, 12,2 años (6,3 a 18,2 años); 56,5% mujeres, zIMC al ingreso 2,92 (1,7 a 7,7); PC 92,3 ± 11,1cm; HOMA 2,45 (0,37 a 17,79). El 39,1% presentaba un CT > 170 mg/dL; 26,5%; LDL > 110 mg/dL; 30,9% HDL < 40 mg/dL y 37%; TG > 110 mg/dl. El 66,9% completó el programa, 68,4% de éstos bajó el zIMC (3,13 ingreso vs 2,77 cuarto mes, p < 0,05) sin relación con edad, sexo, ni zIMC inicial. El grupo que completó el programa tenía un zIMC al ingreso significativamente mayor (3,1 ví 2,74, p < 0,05). Del grupo con exámenes alterados al ingreso y repitieron al cuarto mes, 54% disminuyeron HOMA, 59% bajaron el CT y 66% los TG, sin relación con descenso ponderal, disminución de PC, ni HOMA. Conclusión: Un alto porcentaje de los niños(as) completa el programa, presentando mayor adherencia quienes tienen zIMC más alto al ingreso. El programa logra mejoría en estado nutricional y variables metabólicas a corto plazo, y justificaría su aplicación en atención primaria de salud.

Reducing the prevalence of childhood obesity is a sanitary goal for the decade. Objective: To evaluate a short time intervention model in childhood obesity on its anthropometric and metabolic impact. Methods: Prospective evaluation of obese children and adolescents, 6 to 19 years of age. A pilot treatment program from the Public Health System and FONASA was conducted as a multidisciplinary, non-pharmacologic intervention, during a 4-month follow-up period. Body Mass Index (BM1), waist circumference, lipid profile, plasma glucose and HOMA index were evaluated. In a subset of the subjects the blood profile was repeated on the 4th month. Results: 402 patients entered the program, 56,5% females, age 12,2 years (range 6,3-18,2). Baseline mean BMl z score was 2,92 (1,7 to 7,7), mean waist circumference was 92,3 ±11,1 cm. A total cholesterol (TC) >170 mg/dL was founded in 39,1% of patients; LDL >110 mg/ dL, 26,5%; HDL < 40 mg/dL, 30,9%, and TG > 110 mg/ dL in 37% of patients. The median HOMAwas 2,45 (0,37 to 17,79). The program was completed by 66,9% of patients, 68,4% of these reduced z score BMl at the 4-month evaluation (3,13 baseline vs 2,74, p < 0.05), without correlation with age, gender, or baseline BMl z score. The group who completed the program showed a BMl z score at baseline significantly higher than their counterparts (3,1 vs 2,74, p < 0,05). 118 subjects were reevaluated, 59 % of them showed a decrease in HOMA index. From the group of patients with high TC levels at baseline, 54% reduced the TC and 66% TG, without relation to weight, waist circumference or HOMA reduction. Conclusion: a high percentage of children succeeded in completing the program, showing better adherence those who were more overweight at the entrance of the program. The program showed an improvement in the nutritional state and in metabolic factors.

Recomendações dietéticas no tratamento da obesidade infantil: semelhanças e discrepâncias segundo categoria profissional / Dietary recommendations to treat childhood obesity: similarities and differences according to the professional category / Recomendaciones dietéticas para el tratamiento de la obesidad infantil: semejanzas y discrepancias de acuerdo con la categoría profesional

A obesidade infantil já é considerada um problema de saúde pública em ascensão, sendo fundamental a discussão sobre a forma de tratamento realmente eficiente. O objetivo deste trabalho é conhecer o protocolo de tratamento de pediatras, endocrinologistas e nutricionistas que atuam na cidade de Fortaleza, Ceará, incluindo modalidade terapêutica, dieta prescrita e critérios de avaliação para alta do paciente. Para a coleta de dados, utilizou-se um formulário semiestruturado, que foi enviado a esses profissionais em seus locais de trabalho. Os resultados indicam, entre as orientações prescritas como práticas principais e unânimes entre as categorias profissionais: modificações na alimentação da família, aumento no consumo de frutas e hortaliças e restrição de alimentos específicos (guloseimas doces e salgadas, massas e frituras). Dieta individualizada é uma conduta adotada pela maioria dos nutricionistas, seguidos pelos endocrinologistas. Outras orientações dietéticas importantes e constantes em referenciais teóricos de consenso foram lembradas por poucos profissionais, independente da categoria na qual estava inserido. Concluiu-se que o uso de dietas previamente planejadas, sem direcionamento a um cliente em particular e/ou a orientação genérica de elevação e restrição de alimentos pode ser uma prática mais comum a pediatras e endocrinologistas.

Childhood obesity is considered an increasing public health problem,making it elementary the discussion on how to treat it effectively. This study aimed to investigate the dietary recommendations prescribed by health professionals such as pediatricians, endocrinologists and nutritionists that work in the city of Fortaleza, Ceará, Brazil, taking into account their therapeutic style, diet prescriptions and criteria toevaluate the recovery of patients. For data collection a semi-structured questionnaire was conducted with the health professionals in their workplaces. The results show that the three categories of professionals use the same guidelines regarding their prescriptions, moreover, there were changes in family nutrition, increased consumption of fruits and vegetables and restriction of specific foods (sweet and salty snacks, pastries and fried foods). Diet is an individualized procedure adopted by most nutritionists, followed by endocrinologists. Other important dietary guidelines acknowledged as theoretical references were remembered by very few professionals; regardless of the category in which they were inserted. It can be concluded from this study that the use of previously planned diet without being directed to a particular patient and/or generalorientation of rising or restricting food can be a common practice among pediatricians and endocrinologists.

La obesidad infantil ya se considera un problema de salud pública en ascenso, siendo fundamental el debate sobre la forma de tratamiento realmente eficaz. El objetivo de este estudio es conocer el protocolo del tratamiento de pediatras, endocrinólogos y nutricionistas, que actúan en la ciudad de Fortaleza, Ceará, Brasil, incluyendo la modalidad terapéutica, la dieta prescrita y los criterios de evaluación para el alta del paciente. Parala recolecta de datos se utilizó un formulario semiestructurado, el cual fue enviado a esos profesionales en sus lugares de trabajo. Los resultados indican que entre las orientaciones prescritas, como practicas principales y unánimes entre las categorías profesionales, están: modificaciones en la alimentación familiar, el aumento del consumo de frutas y hortalizas y la restricción de determinados alimentos (golosinas dulces y saladas, pastas y frituras). Una dieta individualizada es una conducta adoptada por la mayoría de los nutricionistas, seguidos por los endocrinólogos. Otras importantes y constantes orientaciones dietéticas en referencias teóricas de consenso fueron recordadas por algunos profesionales, independientemente de la categoría a la cual pertenecen. Se concluye que el uso de dietas, previamente planificadas, sin ser destinada a un cliente en particular y/o a orientación genérica de aumento y restricción de alimentos, puede ser una práctica más común a pediatras y endocrinólogos.

Sibutramine versus Metformin: assessment of anthropometric, lipid and glycemic parameters in obese and overweight high-risk patients

Anthropometric, lipid and glycemic parameters were compared in obese or overweight high-risk patients. This double-blind trial included 16 obese and overweight patients who followed a standard calorie-controlled diet and received 15mg/day sibutramine or 1700mg/day metformin over three months. The changes observed in the sibutramine and metformin groups were, respectively: body mass index -6.0% and -4.0%; abdominal circumference -7.9% and -6.6%; fatty tissue -10.5% and -1.7%; total cholesterol -2.9% and -2.8%; LDL-C -0.01% and -0.1%; HDL-C -11.0% and -6.8%; total cholesterol/ HDL-C ratio +12.0% and +4.5%; HDL-C-to-LDL-C ratio -7.2% and -0.1%; triglycerides +14.0% and +22.3%; fasting glucose +4.3% and +1.4%; insulin -10.4% and -4.9%; HOMA -8.0% and -3.9%. Although the study was conducted with only 16 patients and the drugs were taken for only three months, we can see that sibutramine-treated obese or overweight high-risk patients showed a reduction of anthropometric parameters and better control of insulin resistance.

Comparar os parâmetros antropométricos, lipídicos e glicêmicos em pacientes obesos ou sobrepeso de risco elevado. Estudo duplo cego com 16 pacientes obesos ou em sobrepeso de risco elevado que receberam tratamento com dieta mais 15mg/dia de sibutramina ou 1700mg/dia de metformina durante três meses. As mudanças nos parâmetros avaliados no grupo sibutramina e metformina foram: índice de massa corporal (-6,0% vs. -4,0%), circunferência abdominal (-7,9% vs. -6,6%), tecido adiposo (-10,5% vs. -1,7%), colesterol total (-2,9% vs. -2,8%), LDL-C (-0,01% vs. -0,1%), HDL-C (-11,0% vs. -6,8%), razão colesterol total/HDL-C (12,0% vs. 4,5%), razão HDL-C/LDL-C (-7,2% vs. -0,1%), triglicerídeos (14,0% vs. 22,3%), glicemia de jejum (4,3% vs. 1,4%), insulina (-10,4% vs. -4,9%), HOMA (-8,0% vs. -3,9%). Embora o estudo tenha sido conduzido com somente 16 pacientes e o uso dos medicamentos ter sido por apenas três meses, pode-se observar que o tratamento com sibutramina em pacientes obesos ou sobrepeso de risco elevado mostrou uma redução nos parâmetros antropométricos e melhor controle na resistência a insulina.

Programa MINSAL-FONASA para tratamiento de la obesidad infanto-juvenil / MINSAL-FONASA pilot study in obese children and adolescents

Reducing the prevalence of childhood obesity is a sanitary goal for the decade. Objective: To evaluate a short time intervention model in childhood obesity on its anthropometric and metabolic impact. Methods: Prospective evaluation of obese children and adolescents, 6 to 19 years of age. A pilot treatment program from the Public Health System and FONASA was conducted as a multidisciplinary, non-pharmacologic intervention, during a 4-month follow-up period. Body Mass Index (BM1), waist circumference, lipid profile, plasma glucose and HOMA index were evaluated. In a subset of the subjects the blood profile was repeated on the 4th month. Results: 402 patients entered the program, 56,5 percent females, age 12,2 years (range 6,3-18,2). Baseline mean BMl z score was 2,92 (1,7 to 7,7), mean waist circumference was 92,3 +/-11,1 cm. A total cholesterol (TC) >170 mg/dL was founded in 39,1 percent of patients; LDL >110 mg/dL, 26,5 percent; HDL < 40 mg/dL, 30,9 percent, and TG > 110 mg/dL in 37 percent of patients. The median HOMA was 2,45 (0,37 to 17,79). The program was completed by 66,9 percent of patients, 68,4 percent of these reduced z score BMl at the 4-month evaluation (3,13 baseline vs 2,74, p < 0.05), without correlation with age, gender, or baseline BMl z score. The group who completed the program showed a BMl z score at baseline significantly higher than their counterparts (3,1 vs 2,74, p < 0,05). 118 subjects were reevaluated, 59 percent of them showed a decrease in HOMA index. From the group of patients with high TC levels at baseline, 54 percent reduced the TC and 66 percent TG, without relation to weight, waist circumference or HOMA reduction. Conclusion: a high percentage of children succeeded in completing the program, showing better adherence those who were more overweight at the entrance of the program. The program showed an improvement in the nutritional state and in metabolic factors.

La disminución de la obesidad es un objetivo sanitario para la década. Objetivo: Evaluar respuesta antropométrica, metabólica y adherencia a corto plazo, a un modelo de intervención en obesidad infantil. Sujetos y Método: Niños(as) obesos, 6-19 años, ingresados a un programa piloto; intervención multidisciplinaria, de 4 meses de duración. Se evaluó al ingreso y 4 meses 1MC, perímetro de cintura (PC), lípidos plasmáticos, glice-mia e insulinemia. Resultados: Ingresaron 402 pacientes, 12,2 años (6,3 a 18,2 años); 56,5 por ciento mujeres, zIMC al ingreso 2,92 (1,7 a 7,7); PC 92,3 +/- 11,1cm; HOMA 2,45 (0,37 a 17,79). El 39,1 por ciento presentaba un CT > 170 mg/dL; 26,5 por ciento; LDL > 110 mg/dL; 30,9 por ciento HDL < 40 mg/dL y 37 por ciento; TG > 110 mg/dl. El 66,9 por ciento completó el programa, 68,4 por ciento de éstos bajó el zIMC (3,13 ingreso vs 2,77 cuarto mes, p < 0,05) sin relación con edad, sexo, ni zIMC inicial. El grupo que completó el programa tenía un zIMC al ingreso significativamente mayor (3,1 ví 2,74, p < 0,05). Del grupo con exámenes alterados al ingreso y repitieron al cuarto mes, 54 por ciento disminuyeron HOMA, 59 por ciento bajaron el CT y 66 por ciento los TG, sin relación con descenso ponderal, disminución de PC, ni HOMA. Conclusión: Un alto porcentaje de los niños(as) completa el programa, presentando mayor adherencia quienes tienen zIMC más alto al ingreso. El programa logra mejoría en estado nutricional y variables metabólicas a corto plazo, y justificaría su aplicación en atención primaria de salud.

The Malaysian Childhood Obesity Treatment Trial (MASCOT)

Introduction: The present study describes a randomised controlled trial (RCT) based on a novel, generalisable intervention for childhood obesity, comparing the intervention with a no-treatment control group. Method: The Malaysian Childhood Obesity Treatment Trial (MASCOT) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age (7 to 11 years old) in Kuala Lumpur, Malaysia. The MASCOT comprising eight sessions, of an 8-hour family-centred group treatment programme is described, based on behavioural change techniques. The study sample was characterised by BMI zscore, health related quality of life reported by participants and their parents (PedsQL questionnaire), objectively measured habitual physical activity and sedentary behaviour (Actigraph accelerometry) Results: The MASCOT sample of 107 children was characterised by a low quality of life, mean total score on PedsQL 67.7 (4.5) as reported by the children, and 66.0 (16.4) as reported by their parents. The children spent, on average, 89% of their waking day on sedentary activity, and 1% of the day in moderate-vigorous intensity physical activity, equivalent to only around 8 minutes/day. Conclusion: Obese children in the MASCOT study had an impaired quality of life, high levels of sedentary behaviour and very low levels of physical activity.