Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort / Fatores de risco para menor compensação renal pós-nefrectomia: análise de doadores de rim vivo em uma coorte amazônica

Abstract Introduction: Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified. Objective: To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy. Methods: This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected. Results: The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]). Conclusion: Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.

Resumo Introdução: O transplante de rim de doador vivo é considerado a terapia renal substitutiva ideal por oferecer menor taxa de complicações e possibilitar uma resposta eficiente à grande demanda por enxertos no sistema de saúde. A seleção criteriosa e o acompanhamento adequado dos doadores constituem um pilar fundamental dessa modalidade terapêutica, sendo essencial a identificação dos indivíduos em maior risco de disfunção renal pós-nefrectomia. Objetivo: Identificar fatores de risco para uma Taxa de Compensação (TC) da função renal inferior a 70% 12 meses após a nefrectomia. Métodos: Estudo observacional, retrospectivo e longitudinal conduzido com doadores de rim vivo acompanhados no Hospital Regional do Baixo Amazonas entre 2016 e 2022. Foram coletados dados correspondentes a variáveis sociodemográficas, comorbidades e parâmetros de função renal. Resultados: Foram incluídos 32 pacientes na amostra final. Destes, 14 (43,75%) obtiveram TC < 70% 12 meses após a doação. A regressão logística identificou a obesidade (Odds Ratio [IC95%]: 10.6 [1.7-65.2]), albuminúria (Odds Ratio [IC95%]: 2.41 [1.2-4.84]) e proteinúria (Odds Ratio [IC95%]: 1.14 [1.03-1.25]) como fatores de risco. A taxa de filtração glomerular atuou como fator de proteção (Odds Ratio [IC95%]: 0.92 [0.85-0.99]). Conclusão: Obesidade, albuminúria e proteinúria demonstraram impacto negativo na taxa de compensação renal em curto prazo, o que reitera a necessidade de estudos acerca das implicações prognósticas desses fatores. Além disso, reforça-se a necessidade de avaliação cuidadosa e individualizada dos possíveis doadores, com acompanhamento rigoroso, especialmente para indivíduos de maior risco.

Impacto de la pandemia por SARS-CoV-2 en el índice de masa corporal de niños asistidos en la Ciudad Autónoma de Buenos Aires / Impact of the SARS-CoV-2 pandemic on the body mass index of children seen in the City of Buenos Aires

Introducción. El sobrepeso y la obesidad infantil constituyen un problema de salud pública. El inicio de la pandemia por COVID-19 pudo haber favorecido esta patología. El puntaje Z del índice de masa corporal (Z-IMC) es un indicador aceptado para su diagnóstico y seguimiento. Objetivo. Evaluar si la prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó durante la pandemia. Población y métodos. Estudio de cohorte retrospectiva. Se incluyeron pacientes asistidos en efectores públicos de salud del Gobierno de la Ciudad Autónoma de Buenos Aires (GCABA), de 2 a 5 años de edad, con registro de peso y talla en dos consultas, antes y después de haber comenzado el aislamiento social preventivo y obligatorio (ASPO). Se registró estado nutricional (Z-IMC) y variación del Z-IMC entre ambas consultas. Resultados. Se evaluaron 3866 sujetos, edad promedio 3,4 ± 0,8 años; el 48,1 % fueron mujeres. El intervalo promedio entre consultas fue 14,3 ± 2,5 meses. La prevalencia de sobrepeso/obesidad aumentó del 12,6 % (IC95% 11,6-13,6) al 20,9 % (IC95% 19,6-22-2); p <0,001, al igual que el Z-IMC (0,4 ± 1,1 vs. 0,8 ± 1,3; p <0,001). Conclusión. La prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó significativamente durante la pandemia.

Introduction. Childhood overweight and obesity are a public health problem. The onset of the COVID-19 pandemic may have contributed to this condition. The body mass index (BMI) Z-score has been accepted as an indicator for overweight and obesity diagnosis and follow-up. Objective. To assess whether the prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased during the pandemic. Population and methods. Retrospective, cohort study. Patients included were those seen at public health care facilities in the City of Buenos Aires (CABA), who were aged 2 to 5 years, had weight and height values recorded at 2 different visits, before and after the establishment of the preventive and mandatory social isolation policy. Patients' nutritional status (BMI Z-score) and the variation in this indicator between both visits were recorded. Results. A total of 3866 subjects were assessed; their average age was 3.4 ± 0.8 years; 48.1% were girls. The average interval between both visits was 14.3 ± 2.5 months. The prevalence of overweight/ obesity increased from 12.6% (95% CI: 11.6­13.6) to 20.9% (95% CI: 19.6­22.2), p < 0.001, and so did the BMI Z-score (0.4 ± 1.1 versus 0.8 ± 1.3, p < 0.001). Conclusion. The prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased significantly during the pandemic.

Efecto de un programa de autocuidado en hábitos de vida saludable con relación a la obesidad en personal de salud de una institución de tercer nivel / Efeito de um programa de autocuidado nos hábitos de vida saudáveis em relação à obesidade em profissionais de saúde de uma instituição terciária / Effect of a self-care program on healthy lifestyle habits in relation to obesity in health personnel of a tertiary institution

Introducción. A nivel mundial, la obesidad es considerada como un problema de salud pública debido a que afecta a la población de todas las edades, incluso al mismo personal que trabaja en instituciones de salud, situación que repercute en su ámbito personal, familiar, pero sobre todo laboral, causando en el trabajador dificultad para realizar algunos procedimientos, ausentismo laboral, discapacidad parcial o total y/o necesidad de cuidado, entre otros.  Objetivo.  Evaluar el efecto de una intervención de autocuidado en hábitos de vida saludable con relación a la obesidad en personal de salud de una institución de tercer nivel.  Metodología. Estudio cuasi experimental, muestra 30 trabajadores con sobrepeso o algún grado de obesidad de una institución de salud de tercer nivel. Se impartieron 10 temas con relación a la obesidad, para cambiar hábitos deficientes por hábitos saludables, además de 10 sesiones de actividad física.    Resultados. Al final de la intervención, dos personas bajaron el nivel de su índice de masa corporal, una persona con obesidad grado III y una de grado II bajaron a peso normal. En cuanto a las medidas antropométricas posterior a la intervención, hubo reducción en cada uno de los parámetros, referente a la evaluación del cuestionario hábitos de vida saludable, relacionados con la obesidad posterior a la intervención, se encontraron cambios positivos en cada una de las dimensiones. Sin embargo, tanto en la reducción de IMC, así como en las dimensiones del cuestionario, la diferencia encontrada, no fue estadísticamente significativa.  Conclusiones. Los resultados sugieren que una intervención educativa en hábitos de vida saludable vinculados con la obesidad en personal de salud, son eficaces para contribuir al autocuidado de los trabajadores en el ámbito laboral

Introduction. Worldwide, obesity is considered a public health problem because it affects the population of all ages, including the same personnel who work in health institutions, a situation that has repercussions in their personal and family environment, but above all at work, causing the worker difficulty in performing some procedures, absenteeism, partial or total disability and/or need for care, among others. Objective. To evaluate the effect of a self-care intervention on healthy life habits in relation to obesity in health personnel of a third level institution. Methodology. Quasi-experimental study, sample of 30 workers with overweight or some degree of obesity in a tertiary health institution. Ten topics related to obesity were taught in order to change deficient habits for healthy habits, in addition to 10 sessions of physical activity. Results. At the end of the intervention, two people lowered their body mass index level, one person with grade III obesity and one with grade II obesity lowered to normal weight. Regarding the anthropometric measures after the intervention, there was a reduction in each one of the parameters, regarding the evaluation of the healthy life habits questionnaire, related to obesity after the intervention, positive changes were found in each one of the dimensions. However, both in the reduction of BMI and in the dimensions of the questionnaire, the difference found was not statistically significant. Conclusions. The results suggest that an educational intervention on healthy lifestyle habits related to obesity in health personnel is effective in contributing to the self-care of workers in the workplace

Introdução. A nível mundial, a obesidade é considerada um problema de saúde pública porque afecta a população de todas as idades, incluindo o próprio pessoal que trabalha nas instituições de saúde, situação que tem repercussões no seu ambiente pessoal e familiar, mas sobretudo no trabalho, causando ao trabalhador dificuldade na realização de alguns procedimentos, absentismo, incapacidade parcial ou total e/ou necessidade de cuidados, entre outros. Objectivos. Avaliar o efeito de uma intervenção de autocuidado sobre hábitos de vida saudáveis em relação à obesidade em profissionais de saúde de uma instituição de cuidados terciários. Metodologia. Estudo quase-experimental, amostra de 30 trabalhadores com excesso de peso ou algum grau de obesidade numa instituição de saúde terciária. Foram ensinados dez temas relacionados com a obesidade, com o objetivo de mudar hábitos deficientes por hábitos saudáveis, além de 10 sessões de atividade física. Resultados. No final da intervenção, duas pessoas baixaram o índice de massa corporal, uma pessoa com obesidade de grau III e uma com obesidade de grau II passaram para o peso normal. Relativamente às medidas antropométricas após a intervenção, verificou-se uma redução em cada um dos parâmetros, e relativamente à avaliação do questionário de hábitos de vida saudáveis relacionados com a obesidade após a intervenção, verificaram-se alterações positivas em cada uma das dimensões. No entanto, tanto na redução do IMC como nas dimensões do questionário, a diferença encontrada não foi estatisticamente significativa. Conclusões. Os resultados sugerem que uma intervenção educativa sobre hábitos de vida saudáveis ligados à obesidade no pessoal de saúde é eficaz para contribuir para o autocuidado dos trabalhadores no local de trabalho

Mecanismos de pago en salud: resultados de ejecución del pago asociado a diagnóstico en cirugía bariátrica en su primer año de implementación en Chile / Healthcare payment mechanism: Execution results of bundled payment program for bariatric surgery diagnosis in its first year of implementation in Chile

Introducción Más de 600 mil personas en Chile viven con obesidad mórbida. La incorporación de intervenciones terapéuticas eficaces, seguras y costo-efectivas es crítica para los sistemas de salud y esquemas de aseguramiento. En el año 2022 se incorporaron al arancel de modalidad de libre elección del Fondo Nacional de Salud dos códigos de pago asociado a diagnóstico para cirugía bariátrica: gástrico y manga gástrica. El objetivo fue caracterizar la ejecución del programa de mecanismo de pago tipo pago asociado a diagnóstico de cirugía bariátrica en su primer año de implementación. Métodos Estudio descriptivo y observacional de abordaje pragmático de la ejecución nacional del pago asociado a diagnóstico en cirugía bariátrica. Se examinaron variables de caracterización sociodemográfica (sexo, tramos etarios y tramos del Fondo nacional de Salud) y caracterización de cirugías según código desagregadas por prestador público o privado, periodo de emisión, gasto unitario, copago, y préstamos médicos, entre marzo y diciembre de 2022. Resultados Se registraron n = 13 118 cirugías (45,81% versus 54,19% manga), de las cuales n = 2424 (18,48%) emplearon préstamos médicos. Un 85,01% (p = 0,01) de los procedimientos fueron en mujeres; en personas entre 35 y 39 años (20,15%); y 45,12% en beneficiarios del tramo B. El 99,21% de las cirugías se realizó en prestadores privados. Diez de estos concentraron el 50% de la actividad (rango n = 1200 a 426 cirugías anuales; n = 4,8 a 1,7 cirugías por día hábil). El gasto total del programa fue $71 626 948 350 CLP, explicando un 5,04% de la actividad total del Programa nacional de Pago Asociado a Diagnóstico. Conclusiones La implementación de este bono para cirugía bariátrica benefició a más de 13 mil personas que viven con obesidad, mayormente mujeres, en edades productivas, y con capacidad de compra. Como estrategia de equidad, independientemente de la vía de acceso mediante el bono, será importante cautelar la actividad en la red pública.

Introduction More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation. Methods Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022. Results We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program. Conclusions The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.

Sonographic and Anatomical Evaluation of the Liver and Portal Vein Reference Values / Evaluación Ecográfica y Anatómica de los Valores de Referencia del Hígado y la Vena Porta

SUMMARY: This paper's aim is a morphometric evaluation of liver and portal vein morphometry using ultrasonography in healthy Turkish population. This study was carried out with 189 subjects (107 females, 82 males). The demographic data and the body surface area were calculated. The longitudinal axis of the liver for two lobes, diagonal axis or liver span, anteroposterior diameter of the liver and portal vein, portal vein transverse diameter, caudate lobe anteroposterior diameter, and portal vein internal diameters as well as longitudinal liver scans in an aortic plane, sagittal plane, transverse plane, and kidney axis were measured. All measurements were analyzed according to age, sex, body mass index, obesity and alcohol consumption. The mean values of the age, height, weight and body mass index were calculated as 44.39 years, 167.05 cm, 74.23 kg, and 27.06kg/m2 in females, respectively. The same values were 44.13 years, 167.70 cm, 75.93 kg and 26.71 kg/m2 in males, respectively. There was significant difference between demographic characteristics, gender, and alcohol consumption in terms of anteroposterior diameter of the liver, portal vein transverse diameter of the right side and liver transverse scan. Also, some measurements including portal vein transverse diameter, liver transverse scan and at kidney axis longitudinal scan of liver showed significant difference between the age groups. There was significant difference in diagonal axis and anteroposterior diameter of liver, portal vein internal diameter, and longitudinal liver scans of the aortic plane parameters between obesity situation. The findings obtained will provide important and useful reference values as it may determine some abnormalities related liver diseases. Also, age, sex, obesity and body mass index values can be effective in the liver and portal vein morphometry related parameters.

El objetivo de este artículo fue realizar una evaluación de la morfometría del hígado y la vena porta mediante ecografía en una población turca sana. Este estudio se llevó a cabo en 189 sujetos (107 mujeres, 82 hombres). Se calcularon los datos demográficos y la superficie corporal. Se midió eleje longitudinal del de dos lóbulos del hígado, el eje diagonal o la extensión del hígado, los diámetros anteroposterior del hígado y de la vena porta, el diámetro transversal de la vena porta, anteroposterior del lóbulo caudado y los diámetros internos de la vena porta, así como las exploraciones longitudinales del hígado en un plano aórtico. Se midieron el plano sagital, el plano transversal y el eje del riñón. Todas las mediciones se analizaron según edad, sexo, índice de masa corporal, obesidad y consumo de alcohol. Los valores medios de edad, talla, peso e índice de masa corporal se calcularon como 44,39 años, 167,05 cm, 74,23 kg y 27,06 kg/m2 en las mujeres, respectivamente. Las mismas variable fueron 44,13 años, 167,70 cm, 75,93 kg y 26,71 kg/m2. Hubo diferencias significativas entre las características demográficas, el sexo y el consumo de alcohol en términos de diámetro anteroposterior del hígado, diámetro transversal de la vena porta del lado derecho y exploración transversal del hígado. Además, algunas mediciones, incluido el diámetro transversal de la vena porta, la exploración transversal del hígado y la exploración longitudinal del hígado en el eje del riñón, mostraron diferencias significativas entre los grupos de edad. Hubo diferencias significativas en el eje diagonal y el diámetro anteroposterior del hígado, el diámetro interno de la vena porta y los parámetros de las exploraciones hepáticas longitudinales del plano aórtico entre situaciones de obesidad. Los hallazgos obtenidos proporcionarán valores de referencia importantes y útiles ya que pueden determinar algunas anomalías relacionadas con enfermedades hepáticas. Además, los valores de edad, sexo, obesidad e índice de masa corporal pueden ser eficaces en los parámetros relacionados con la morfometría del hígado y la vena porta.

Caracterización de estrategias de mercadeo de alimentos y bebidas no alcohólicas dirigidas a la población infantil y adolescente en puntos de venta, Costa Rica 2018

El objetivo del presente estudio fue caracterizar en los puntos de venta de Costa Rica las estrategias de mercadeo utilizadas en alimentos y bebidas no alcohólicas dirigidas a la población infantil, adolescente y a sus padres o tutores (compradores), que influyen en la compra de productos de alto contenido energético y bajo valor nutricional. La recolección de datos se realizó en el 2018 mediante una guía de observación aplicada al punto de venta (n:12) y un cuestionario dirigido a los padres o tutores (n: 72) de la población infantil y adolescente. Se encontró que la estrategia de mercadeo utilizada con mayor frecuencia en el área de entrada, caja y salida del punto de venta fue la reducción de precios (79,0; 87,5 y 88,0%, respectivamente). En los puntos de venta existe un empleo frecuente y variado de estrategias de mercadeo de productos alimenticios densamente calóricos y con un exceso de nutrientes críticos que son relevantes en salud pública por su asociación con la obesidad y enfermedades no transmisibles.

The aim of this study was to characterize in the retail outlets the marketing strategies used in food and non-alcoholic beverages aimed at children, adolescents, and their parents or guardians (shoppers) which influence the purchase of products of high energy content and low nutritional value in Costa Rica. Data collection was carried out in 2018 with an observation guide applied at the retail outlets (RO) (n: 12) and a questionnaire aimed at parents or guardians (shoppers) (n: 72) of the child and adolescent population. The study found that the marketing strategy most frequently used in the entry, cash and exit area the retail outlets was price reduction (79,0, 87.5 and 88,0%, respectively).There is a frequent and varied use of marketing strategies in retail outlets for calorie-dense food products with an excess of critical nutrients that are relevant in public health due to their association with obesity and non-communicable diseases.

Caracterización del entorno alimentario de una universidad en Medellín, Colombia: retos para la promoción de una alimentación saludable

La obesidad se ha convertido en una de las mayores problemáticas de salud pública a nivel mundial, y Colombia no es ajena a esta situación. El entorno universitario constituye un escenario clave para el abordaje de esta problemática. Objetivo: Caracterizar el entorno alimentario de una universidad en Medellín, Colombia. Materiales y métodos: Se realizó un estudio descriptivo transversal mediante la observación directa y registro en formularios estructurados de todos los establecimientos de venta de alimentos. Se consideraron las siguientes variables: oferta de alimentos, precio, publicidad, facilitadores y barreras. Resultados: Ningún establecimiento se clasificó como saludable. En el 76% de los establecimientos, los paquetes o promociones eran más económicos. En el 62% de los establecimientos se observó que los platos saludables eran más costosos. Solo en dos establecimientos se observó publicidad directa para fomentar una alimentación saludable. Se ofrecían principalmente productos ultraprocesados (53%). Conclusión: los resultados del estudio muestran en general un panorama de un entorno alimentario poco saludable. Este diagnóstico se configura como un insumo importante para la toma de decisiones al interior de la institución para mejorar y promover una alimentación más saludable que permita disminuir el riesgo de desarrollar enfermedades crónicas en la comunidad universitaria.

Nowadays, obesity has become one of the biggest public health challenges worldwide. This scenario includes Colombia as well. Against this background, the university environment constitutes a key scenario for addressing this situation. Research Objective: To characterize the food environment of a university in Medellín, Colombia. Materials and methods: A cross-sectional descriptive study was carried out through direct observation. Additionally, it was used structured forms for recording the data of the food establishments. The research considers the following variables: food supply, prices, advertising, facilitators and barriers. Results: No establishment was classified as healthy. In 76% of the establishments, the food-sets or promotions were cheaper. In 62% of the places under inspection, the healthy dishes were more expensive. Only in two establishments there was direct advertising that promoted healthy eating. In general, mainly ultra-processed edible products (53%) were offered. Conclusion: The results of the study generally paint a picture of an unhealthy food environment. This diagnosis is configured as an important input for decision-making within the institution to improve and promote a healthier diet that reduces the risk of developing chronic diseases in the university community.

Evidencias del efecto del grano integral en las enfermedades crónicas no transmisibles

Los cereales integrales son una categoría de alimentos fundamental para la dieta humana y representan una fuente invaluable de carbohidratos, proteínas, fibras, fitoquímicos, minerales y vitaminas. Muchos estudios han demostrado que el consumo de cereales integrales está relacionado con un menor riesgo de enfermedades crónicas no transmisibles. Sin embargo, varios de sus efectos positivos para la salud parecen desaparecer cuando se refinan los cereales. La pregunta de investigación es cuál sería el efecto de los cereales integrales en la prevención de enfermedades crónicas no transmisibles. Este artículo describe los efectos positivos del consumo de cereales integrales en la prevención de estas enfermedades. Para ello, se realiza una descripción narrativa que revisa los antecedentes disponibles sobre: a) situación epidemiológica en Chile y su relación con la alimentación; b) consumo de cereales integrales en el mundo y en Chile; y c) el efecto del consumo de cereales integrales en la reducción del riesgo de enfermedad cardiovascular. obesidad, diabetes tipo 2 y cáncer. Los antecedentes generales son muy alentadores sobre el efecto positivo del consumo de cereales integrales sobre determinadas enfermedades, especialmente las de origen metabólico. Sin embargo, la incertidumbre de algunas asociaciones negativas merece mayor atención.

Whole grains are a fundamental food category for the human diet and represent an invaluable source of carbohydrates, proteins, fibers, phytochemicals, minerals and vitamins. Many studies have shown that consumption of whole grains is linked to a lower risk of chronic non-communicable diseases. However, several of its positive health effects seem to disappear when grains are refined. The research question is what would be the effect of whole grains in the prevention of Chronic Non-Communicable Diseases. This article describes the positive effects of whole grain consumption in these diseases.To this end, a narrative description is made that reviews the available background on: a) epidemiological situation in Chile and its relationship with diet; b) consumption of whole grains in the world and in Chile; and c) the effect of whole grain consumption on reducing the risk of cardiovascular disease. obesity, type 2 diabetes, and cancer. The general background is very encouraging for a positive effect of whole grain consumption on certain diseases, especially those of metabolic origin. However, the uncertainty of some negative associations deserves further attention.

Caracterización clínico-epidemiológica de pacientes con enfermedad hepática esteatósica asociada a disfunción metabólica previa al trasplante en un hospital de cuarto nivel / Clinical-epidemiological characterization of patients with steatotic liver disease associated with metabolic dysfunction prior to transplantation in a fourth level hospital

Introducción. La enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD) se ha convertido en la enfermedad hepática crónica más frecuente en los países occidentales, causando un aumento en los costos y en la ocupación hospitalaria. La caracterización integral previa al trasplante hepático en pacientes con MASLD es una gran interrogante, especialmente en nuestro medio. El objetivo del presente estudio fue realizar la caracterización clínico-epidemiológica de pacientes trasplantados por cirrosis hepática (CH) descompensada o carcinoma hepatocelular (CHC) asociado a MASLD. Metodología. Se desarrolló un estudio observacional retrospectivo, descriptivo, de corte transversal en el Servicio de Hepatología del Hospital Pablo Tobón Uribe en Medellín, Colombia. Se incluyeron pacientes mayores de 17 años, con diagnóstico de CH o de CHC asociado a MASLD que fueron trasplantados entre los años 2004 a 2017. Resultados. Se encontraron 84 pacientes que fueron trasplantados con esas características. La edad promedio de los pacientes fue de 59±10,5 con una mayor proporción significativa de hombres sobre mujeres, llegando casi al 70 %. Con relación a las comorbilidades, se encontró que el sobrepeso/obesidad, la hipertensión arterial y la diabetes mellitus tipo 2 fueron un hallazgo en el 44,1 %, 33,3 % y 33,3 %, respectivamente. Por otro lado, el 14,5 %, el 33,7 % y el 51,8 % presentaron un Child-Pugh A, B y C, respectivamente. La media del puntaje MELD fue de 18,9±6,26. Con respecto a las complicaciones de la cirrosis, el 77,4 % de los pacientes presentó ascitis, el 61,9 % encefalopatía hepática, el 36,9 % hemorragia del tracto digestivo superior y el 29,8 % peritonitis bacteriana espontánea. Conclusión. Los resultados expuestos mostraron nuestra experiencia en trasplante hepático en pacientes con CH y CHC asociado a MASLD. Se debe realizar una evaluación multidisciplinaria antes y después del trasplante en estos pacientes, haciendo especial énfasis en el manejo de la disfunción metabólica y sus componentes, entre los que se destacan la obesidad y la diabetes mellitus.

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most frequent chronic liver disease in Western countries, causing increased costs and hospital occupancy. The comprehensive pre-transplant characterization in patients with MASLD is a major question, especially in our setting. The aim of the present study was to perform the clinical-epidemiological characterization of transplanted patients with decompensated liver cirrhosis (LC) or hepatocellular carcinoma (HCC) associated with MASLD. Methodology. A retrospective, descriptive, cross-sectional observational study was carried out in the Hepatology Department of the Pablo Tobón Uribe Hospital in Medellin, Colombia. Patients over 17 years of age, with a diagnosis of LC or HCC associated with MASLD who were transplanted between 2004 and 2017 were included. Results. We found 84 patients who were transplanted with these characteristics. The mean age of the patients was 59±10.5 with a significantly higher proportion of men over women, reaching almost 70%. Regarding comorbidities, overweight/obesity, arterial hypertension, and type 2 diabetes mellitus were found in 44.1%, 33.3%, and 33.3%, respectively. On the other hand, 14.5%, 33.7%, and 51.8% had Child-Pugh A, B, and C, respectively. The mean MELD score was 18.9±6.26. Regarding complications of cirrhosis, 77.4% of patients developed ascites, 61.9% hepatic encephalopathy, 36.9% upper gastrointestinal tract hemorrhage, and 29.8% spontaneous bacterial peritonitis. Conclusion. The above results showed our experience of liver transplantation in patients with LC and HCC associated with MASLD. A multidisciplinary evaluation should be performed before and after transplantation in these patients, with special emphasis on the management of metabolic dysfunction and its components, including obesity and diabetes mellitus.

O cuidar do adolescente com obesidade na atenção primária à saúde: perspectivas de gestores e profissionais / The care of obese adolescents in primary health care: perspectives of managers and professionals / Atención a adolescentes con obesidad en atención primaria de salud: perspectivas de gestores y profesionales

RESUMO Objetivo: Descrever e explorar, sob a perspectiva de gestores e profissionais de saúde, o cuidado ofertado ao adolescente com obesidade no âmbito da Atenção Primária à Saúde. Método: Estudo de caso, realizado em município do estado do Ceará-Brasil. A coleta de dados ocorreu em 2022, por meio de entrevistas semiestruturadas. Os dados foram examinados através da Análise de conteúdo de Bardin. Resultados: O cuidado ao adolescente com obesidade é fragmentado, cada profissional atua conforme decisão própria, pois o município não utiliza protocolos que subsidiem a prática assistencial. Foram elencadas potencialidades para o cuidado, sendo a principal a equipe multiprofissional. Quanto às dificuldades, destacou-se a procura do serviço de saúde pelo adolescente. Conclusão: Faz-se necessária uma (re)organização do modelo de atenção ao adolescente com obesidade no município. Além disso, o estudo ressalta a necessidade de maior atenção a obesidade na adolescência e provoca reflexões acerca do cuidado dispensado a este adolescente.

ABSTRACT Objective: Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care. Method: A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis. Results: The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent's demand for health services was highlighted. Conclusion: It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.

RESUMEN Objetivo: Describir y explorar, desde la perspectiva de los gestores y profesionales sanitarios, la atención ofrecida a los adolescentes con obesidad en el ámbito de la Atención Primaria de Salud. Método: Estudio de caso, realizado en un municipio del estado de Ceará-Brasil. Los datos se recogieron en 2022 mediante entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultados: La atención a los adolescentes con obesidad está fragmentada, y cada profesional actúa según su propia decisión, ya que el municipio no utiliza protocolos para subvencionar la práctica asistencial. Se enumeraron las potencialidades asistenciales, siendo la principal el equipo multiprofesional. En cuanto a las dificultades, se destaca la búsqueda del servicio sanitario por parte del adolescente. Conclusión: Es necesario (re)organizar el modelo de atención a los adolescentes con obesidad en el municipio. Además, el estudio pone de manifiesto la necesidad de prestar más atención a la obesidad en la adolescencia y suscita reflexiones sobre la atención prestada a este adolescente.

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study

ABSTRACT Introduction: Obese patients are at risk of complications after cardiac surgery. The aim of this study is to investigate safety and efficacy of a minimally invasive approach via upper sternotomy in this setting. Methods: We retrospectively reviewed 203 obese patients who underwent isolated, elective aortic valve replacement between January 2014 and January 2023 - 106 with minimally invasive aortic valve replacement (MIAVR) and 97 with conventional aortic valve replacement (CAVR). To account for baseline differences, a propensity-matching analysis was performed obtaining two balanced groups of 91 patients each. Results: The 30-day mortality rate was comparable between groups (1.1% MIAVR vs. 0% CAVR, P=0.99). MIAVR patients had faster extubation than CAVR patients (6 ± 2 vs. 9 ± 2 hours, P<0.01). Continuous positive airway pressure therapy was less common in the MIAVR than in the CAVR group (3.3% vs. 13.2%, P=0.03). Other postoperative complications did not differ significantly. Intensive care unit stay (1.8 ± 1.2 vs. 3.2 ± 1.4 days, P<0.01), but not hospital stay (6.7 ± 2.1 vs. 7.2 ± 1.9 days, P=0.09), was shorter for MIAVR than for CAVR patients. Follow-up survival was comparable (logrank P-value = 0.58). Conclusion: MIAVR via upper sternotomy has been shown to be a safe and effective option for obese patients. Respiratory outcome was promising with shorter mechanical ventilation time and reduced need for post-extubation support. The length of stay in the intensive care unit was reduced. These advantages might be important for the obese patient to whom minimally invasive surgery should not be denied.

Compreendendo o termo gordofobia médica a partir da perspectiva de pessoas gordas / Understanding the term medical fatphobia from the perspective of fat people

Resumo O ativismo gordo tem como objetivo unir e mobilizar pessoas gordas, a fim de romper com a inviabilização de seus corpos e denunciar a gordofobia. Há algum tempo, o ativismo vem impulsionando a expressão "gordofobia médica" para denunciar a opressão vivenciada dentro dos serviços de saúde. Este artigo tem como objetivo compreender o termo, a partir da percepção de pessoas gordas. É uma pesquisa qualitativa, com dados coletados por meio de um questionário virtual direcionado a pessoas gordas ou ex-gordas, que alcançou 515 respondentes de todas as regiões do Brasil. Os dados foram analisados utilizando a análise temática, com a criação de seis categorias. Entre os principais resultados, pode-se compreender que a gordofobia médica envolve: despreparo, desrespeito e autoritarismo; reprodução de estereótipos, repulsa e preconceito, desumanização da pessoa gorda, diagnóstico superficial e generalizante, desprezo da queixa, foco no peso e negligência, e precarização do acesso e dos cuidados em saúde. Conclui-se que o estudo auxilia na compreensão do termo gordofobia médica, o que facilita o seu reconhecimento e prevenção na área da saúde.

Abstract Fat activism aims to unite and mobilize fat people to break with the impracticability of these bodies and denounce fatphobia. For some time now, activism has been pushing the expression "medical fatphobia" to denounce the oppression experienced by fat people within health services. This article aims to understand the term, from the perspective of fat people. This is a qualitative research, with data were collected via a virtual questionnaire aimed at fat or formerly fat people, which reached 515 respondents from all regions of Brazil. Data were analyzed using thematic analysis, with the creation of six categories. Among the main results, it can be understood that medical fatphobia involves: unpreparedness, disrespect and authoritarianism; reproduction of stereotypes, disgust and prejudice; dehumanization of the fat person; superficial and generalizing diagnosis; dismissal of the complaint, focus on weight and negligence; and precarious access to the health care. In conclusion, the work helps in understanding the term medical fatphobia, which facilitates its recognition and prevention in the health field.

Use of FGF21 analogs for the treatment of metabolic disorders: a systematic review and meta-analysis

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.

Food patterns associated with overweight in 7-11-year old children: machine-learning approach / Padrões alimentares associados ao excesso de peso em crianças de 7 a 11 anos: abordagem de aprendizado de máquina

Abstract Longitudinal study, whose objective was to present a better strategy and statistical methods, and demonstrate its use with the data across the 2013-2015 period in schoolchildren aged 7 to 11 years, covered with the same food questionnaire (WebCAAFE) survey in Florianopolis, southern Brazil. Six meals/snacks and 32 foods/beverages yielded 192 possible combinations denominated meal/snack-Specific Food/beverage item (MSFIs). LASSO algorithm (LASSO-logistic regression) was used to determine the MSFIs predictive of overweight/obesity, and then binary (logistic) regression was used to further analyze a subset of these variables. Late breakfast, lunch and dinner were all associated with increased overweight/obesity risk, as was an anticipated lunch. Time-of-day or meal-tagged food/beverage intake result in large number of variables whose predictive patterns regarding weight status can be analyzed by machine learning such as LASSO, which in turn may identify the patterns not amenable to other popular statistical methods such as binary logistic regression.

Resumo Estudo longitudinal cujo objetivo foi apresentar melhores estratégia e métodos estatísticos e demonstrar sua utilização com os dados do período 2013-2015 em escolares de 7 a 11 anos, contemplados com o mesmo questionário alimentar (WebCAAFE) em Florianópolis, Sul do Brasil. Seis refeições/lanches e 32 alimentos/bebidas resultaram em 192 combinações possíveis denominadas item refeição/lanche-alimentos/bebidas específicos (MSFIs). O algoritmo LASSO (LASSO-regressão logística) foi usado para determinar os MSFIs preditivos de sobrepeso/obesidade e, em seguida, a regressão binária (logística) foi usada para analisar um subconjunto dessas variáveis. Café da manhã, almoço e jantar tardios foram todos associados ao aumento do risco de sobrepeso/obesidade, assim como um almoço antecipado. O consumo de alimentos/bebidas marcados na hora do dia ou na refeição resulta em um grande número de variáveis ​​cujos padrões preditivos em relação ao status do peso podem ser analisados ​​por LASSO. Essa análise pode identificar os padrões não passíveis de outros métodos estatísticos populares, como a regressão logística binária.

Covibesity e o peso das normas. Uma epidemia cultural / Covibesity and the weight of the norms. A cultural epidemic

Resumo A forma como moldamos e apresentamos socialmente o nosso corpo tem uma extraordinária importância social: a aparência é o nosso primeiro cartão de visita a partir do qual as pessoas nos enquadram e julgam. Esta avaliação acaba por condicionar o nosso quotidiano, desde às nossas oportunidades sociais até às profissionais. Um dos critérios mais importantes para determinar se uma pessoa é saudável e bonita - em Portugal, assim como em muitos outros contextos - é a magreza. Numa sociedade em que a magreza e a perfeição física são ideais a perseguir, este artigo explora através de metodologias qualitativas o impacto do discurso ligado ao problema da obesidade causado pela pandemia de COVID-19 na multiplicação e exacerbação de conflitos relacionados com o corpo em mulheres portuguesas entre os 18 e os 65 anos.

Abstract How we shape and socially present our body has extraordinary social importance: appearance is our first business card by which people frame and judge us. This evaluation ends up conditioning our daily lives, from social to professional opportunities. In Portugal, as in many other contexts, one of the most important criteria for determining whether someone is healthy and beautiful is thinness. In a society where thinness and physical perfection are pursuable ideals, this article explores through qualitative methodologies the impact of the discourse linked to the problem of obesity caused by the COVID-19 pandemic on the multiplication and exacerbation of body-related conflicts in Portuguese women aged 18 to 65.

Evaluation of cardiac autonomic function and low-grade inflammation in children with obesity living in the Northeast Brazilian region

Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.

Avaliação da gravidade dos sinais e sintomas da COVID-19 em pacientes submetidos à cirurgia bariátrica / Assessment of the severity of signs and symptoms of COVID-19 in patients undergoing bariatric surgery / Evaluación de la gravedad de los signos y sintomas de COVID-19 em pacientes sometidos a cirurgía bariátrica

Objetivo: Avaliar a gravidade e a incidência dos sinais e sintomas da COVID-19 em pacientes bariátricos, relacionando-os ao índice de massa corporal (IMC) e a outros fatores considerados de risco para a doença.Método: trata-se de um estudo transversal. Os pacientes responderam a um questionário eletrônico e a avaliação da gravidade dos sinais e sintomas da infecção por SARS-CoV-2 foi realizada seguindo o manual "Orientações para manejo de pacientes com covid-19", do Ministério de Saúde do Brasil. Resultados: um total de 60 pacientes foram incluídos. Dos participantes, 60% apresentaram sintomas graves e a fadiga foi o sintoma mais frequente (90%). A análise mostrou uma associação significativa entre a presença de tosse e a condição de sobrepeso/obesidade (OR=3,720; IC=1,060­13,050; p=0,034). Além disso, apenas 6,7% foram hospitalizados, sem casos de intubação, todos com sobrepeso/obesidade (OR=1,333; IC=1,114­1,554). Conclusão:apesar de uma alta taxa de pacientes categorizados com sinais e sintomas graves, verificou-se uma baixa necessidade de internação hospitalar e ventilação mecânica não invasiva. Isso sugere que a perda de peso e a melhora das comorbidades pós-cirurgia podem contribuir para um risco reduzido de hospitalização em casos de infecção por COVID-19

Objective: To assess the severity and incidence of COVID-19 signs and symptoms in bariatric patients, relating them to body mass index (BMI) and other risk factors for the disease. Method:This is a cross-sectional study. Patients completed an electronic questionnaire, and the severity of SARS-CoV-2 infection signs and symptoms was assessed following the "Guidelines for the management of COVID-19 patients" by the Brazilian Ministry of Health. Results:A total of 60 patients were included. Among the participants, 60% presented with severe symptoms, with fatigue being the most frequent symptom (90%). The analysis showed a significant association between the presence of cough and the condition of overweight/obesity (OR=3.720; CI=1.060­13.050; p=0.034). Moreover, only 6.7% were hospitalized, with no cases requiring intubation, all within the overweight/obesity subgroup (OR=1.333; CI=1.114­1.554).Conclusion: Despite a high rate of patients categorized with severe signs and symptoms, there was a low need for hospital admission and non-invasive mechanical ventilation. This suggests that weight loss and improvement of comorbidities post-surgery may contribute to a reduced risk of hospitalization in COVID-19 infection case.

Objetivo: Evaluar la gravedad y la incidencia de los signos y síntomas de COVID-19 en pacientes bariátricos, relacionándolos con el índice de masa corporal (IMC) y otros factores de riesgo para la enfermedad. Metodo:Se trata de un estudio transversal. Los pacientescompletaron un cuestionario electrónico, y la gravedad de los signos y síntomas de la infección por SARS-CoV-2 se evaluó siguiendo las "Guías para el manejo de pacientes con COVID-19" del Ministerio de Salud de Brasil. Resultados:Se incluyó un total de 60 pacientes. Entre los participantes, el 60% presentó síntomas severos, siendo la fatiga el síntoma más frecuente (90%). El análisis mostró una asociación significativa entre la presencia de tos y la condición de sobrepeso/obesidad (OR=3.720; IC=1.060­13.050; p=0.034). Además, solo el 6.7% fueron hospitalizados, sin casos que requirieran intubación, todos dentro del subgrupo de sobrepeso/obesidad (OR=1.333; IC=1.114­1.554). Conclusión:A pesar de una alta tasa de pacientes clasificados con signos y síntomasseveros, hubo una baja necesidad de admisión hospitalaria y ventilación mecánica no invasiva. Esto sugiere que la pérdida de peso y la mejora de las comorbilidades postoperatorias pueden contribuir a un riesgo reducido de hospitalización en casos de infección por COVID-19

Impact of pre-operative weight loss on non-alcoholic fatty liver disease histopathology and insulin resistance in individuals undergoing bariatric surgery: a propensity matched cross-sectional comparison

ABSTRACT BACKGROUND: The effect of weight loss (WL) on histopathological aspects of non-alcoholic fatty liver disease (NAFLD) may provide further insights into the dynamics of hepatic recovery after WL. OBJECTIVE: To analyze the effects of pre-operative WL on insulin resistance- and NAFLD-related histology in individuals undergoing bariatric surgery (BS) with or without pre-operative WL. DESIGN AND SETTING: A matched cross-sectional study was conducted at a public university hospital and a private clinic in Campinas, Brazil. METHODS: An analytical, observational, cross-sectional study was conducted using prospectively collected databases of individuals who underwent BS and liver biopsy at either a public tertiary university hospital (with pre-operative WL) or a private clinic (without pre-operative WL). Random electronic matching by gender, age, and body mass index (BMI) was performed and two paired groups of 24 individuals each were selected. RESULTS: Of the 48 participants, 75% were female. The mean age was 37.4 ± 9.6. The mean BMI was 38.9 ± 2.6 kg/m2. Fibrosis was the most common histopathological abnormality (91.7%). Glucose was significantly lower in the WL group (92 ± 19.1 versus 111.8 ± 35.4 mg/dL; P = 0.02). Significantly lower frequencies of macrovesicular steatosis (58.3% versus 95.8%; P = 0.004), microvesicular steatosis (12.5% versus 87.5%; P < 0.001), and portal inflammation (50% versus 87.5%; P = 0.011) were observed in the WL group. CONCLUSION: Pre-operative WL was significantly associated with lower frequencies of macro- and mi- crovesicular steatosis, portal inflammation, and lower glycemia, indicating an association between the recent trajectory of body weight and histological aspects of NAFLD.

Fatores socioeconômicos, clínicos e nutricionais no ganho de peso interdialítico em usuários de hemodiálise / Factores socioeconómicos, clínicos y nutricionales en el aumento de peso interdialítico en usuarios de hemodiálisis / Socioeconomic, clinical and nutritional factors on interdialytic weight gain in haemodialysis users

Resumo Objetivo Avaliar os fatores associados ao ganho de peso interdialítico em usuários de serviços de hemodiálise em uma Região Metropolitana do Brasil. Métodos Estudo epidemiológico transversal envolvendo 1.024 indivíduos com doença renal crônica em hemodiálise no Brasil. O ganho de peso interdialítico foi avaliado pelo percentual de ganho de peso entre uma sessão de hemodiálise e outra. As variáveis incluídas na análise de regressão logística binária foram selecionadas considerando p< 0,10 no teste bivariado. Resultados Demonstramos que ter mais anos de estudo (OR=0,537;IC 95% = 0,310-0,931; p=0,027) e sobrepeso (OR=0,661;IC 95% = 0,461-0,948; p=0,024) ou obesidade ( OR=0,387;IC 95% = 0,246-0,608; p=<0,001) reduziu as chances de os usuários apresentarem alto ganho de peso interdialítico. Usuários sem trabalho remunerado (OR=2,025; IC 95% = 1,218-3,365; p=0,007) e que não adotavam medidas para reduzir o sal (OR=1,694; IC 95% = 1,085-2,645; p=0,020) tiveram maiores chances de ganho de peso interdialítico. Conclusão Os resultados apontam para associação entre o aumento do ganho de peso interdialítico e a ausência de trabalho remunerado e a não adoção de medidas para reduzir a ingestão de sal na dieta. Portanto, o conhecimento sobre esses fatores associados pode ser uma alternativa importante para o direcionamento individualizado dessa população.

Resumen Objetivo Evaluar los factores asociados al aumento de peso interdialítico en usuarios de servicios de hemodiálisis en una región metropolitana de Brasil. Métodos Estudio epidemiológico transversal que incluyó 1.024 individuos con enfermedad renal crónica en hemodiálisis en Brasil. El aumento de peso interdialítico se evaluó mediante el porcentaje de aumento de peso entre una sesión de hemodiálisis y otra. Las variables incluidas en el análisis de regresión logística binaria fueron seleccionadas considerando p< 0,10 en la prueba bivariada. Resultados Se demostró que tener más años de estudio (OR=0,537;IC 95 % = 0,310-0,931; p=0,027) y sobrepeso (OR=0,661;IC 95 % = 0,461-0,948; p=0,024) u obesidad ( OR=0,387;IC 95 % = 0,246-0,608; p=<0,001) redujo las chances de que los usuarios presenten un elevado aumento de peso interdialítico. Usuarios sin trabajo remunerado (OR=2,025; IC 95 % = 1,218-3,365; p=0,007) y que no adoptaban medidas para reducir la sal (OR=1,694; IC 95 % = 1,085-2,645; p=0,020) tuvieron más chances de aumento de peso interdialítico. Conclusión Los resultados señalan una relación entre el aumento de peso interdialítico y la ausencia de trabajo remunerado y la no adopción de medidas para reducir la ingesta de sal en la dieta. Por lo tanto, el conocimiento sobre estos factores asociados puede ser una alternativa importante para la orientación individualizada de esta población.

Abstract Objectives The study aimed to evaluate the factors associated with interdialytic weight gain in users of haemodialysis services in a metropolitan region of Brazil. Methods This is an cross-sectional epidemiological study with 1,024 individuals with chronic kidney disease on haemodialysis in Brazil. Interdialytic weight gain was evaluated by the percentage weight gain between one haemodialysis session and another. The variables included in the binary logistic regression analysis were selected by considering p< 0.10 in the bivariate test. Results We demonstrated that having more years of study (OR=0.537;CI 95% = 0.310-0.931; p=0.027) and be overweight (OR=0.661;CI 95% = 0.461-0.948; p=0.024) or obese (OR=0.387;CI 95% = 0.246-0.608; p=<0.001) reduced the chances of users having high interdialytic weight gain. Those who did not have paid work (OR=2.025;CI 95% = 1.218-3.365; p=0.007) and not adopting measures to reduce salt increased (OR=1.694;CI 95% = 1.085-2.645; p=0.020) increased the chances of interdialytic weight. Conclusion The results point to an association between the increase in interdialytic weight gain and the absence of paid work and the non-adoption of measures to reduce salt intake in the diet. Therefore, the need for knowledge about these associated factors can be an important alternative for the individual targeting of this population.

Maternal overweight and obesity before pregnancy as predictors of childhood asthma in children under five years: a retrospective cohort in Peru / Sobrepeso y obesidad materna antes del embarazo como predictores de asma infantil en menores de cinco años: una cohorte retrospectiva en Perú

Abstract Objectives: to estimate the role of maternal overweight and obesity before pregnancy as predictors of childhood asthma in a population of Peruvian children under five years. Methods: we carried out a retrospective cohort study of children aged five years or less and their mothers from the Regional Hospital of Ayacucho and the María Auxiliadora Hospital in Lima, Peru. We included children who were born between 2013 and 2014 and follow them up until 2018 and 2019, respectively. The diagnosis of overweight and obesity of the mother before pregnancy and asthma in the child were registered in their clinical histories. Crude (cRR) and adjusted relative risks (aRR) and 95% confidence intervals (CI95%) were obtained using a generalized lineal model of the Poisson family with link log and robust variances. Results: we evaluated 431 medical records and found that 20.9% of the children had asthma, 26.7% of the mothers were overweight, and 20.2% were obese before pregnancy. In the adjusted regression model, overweight (aRR=2.94; CI95%= 1.54-5.60) and maternal obesity (aRR=5.10; CI95%= 2.73-9.51) were predictors of an increased risk of childhood asthma. Conclusions: maternal overweight and maternal obesity increased the risk of her children developing asthma threeand five-fold, respectively.

Resumen Objetivos: estimar el papel del sobrepeso y la obesidad materna antes del embarazo como predictores de asma infantil en una población de niños peruanos menores de cinco años. Métodos: realizamos un estudio de cohorte retrospectivo de niños de cinco años o menos y sus madres del Hospital Regional de Ayacucho y del Hospital María Auxiliadora de Lima, Perú. Se incluyeron niños nacidos entre 2013 y 2014 y se les dio seguimiento hasta 2018 y 2019, respectivamente. El diagnóstico de sobrepeso y obesidad de la madre antes del embarazo y asma en el niño fueron registrados en sus historias clínicas. Los riesgos relativos crudos (cRR) y ajustados (RRa) y los intervalos de confianza del 95% (IC95%) se obtuvieron mediante un modelo lineal generalizado de la familia de Poisson con log de enlace y varianzas robustas. Resultados: se evaluaron 431 historias clínicas y se encontró que el 20,9% de los niños tenían asma, el 26,7% de las madres tenían sobrepeso y el 20,2% eran obesas antes del embarazo. En el modelo de regresión ajustada, el sobrepeso (aRR=2,94; IC95%= 1,54-5,60) y obesidad materna (RRa=5,10; IC95%= 2,73-9,51) fueron predictores de un mayor riesgo de asma infantil. Conclusiones: el sobrepeso materno y la obesidad materna aumentaron tres y cinco veces el riesgo de que sus hijos desarrollaran asma, respectivamente.