Obesidad: alternativas al paradigma pesocéntrico y patologizante. Primera entrega / Obesity: alternatives to the weight-centric and pathologizing paradigm. First part

Si bien para los médicos la obesidad es una palabra técnica, para muchas personas tiene la implicaría de un largo sufrimiento en relación a su cuerpo. Históricamente, la medicina tradicional se ha comportado como una barrera en la atención a las personas con exceso de peso debido a la gordofobia y a una perspectiva reduccionista pesocentrista. Es preocupante que las ciencias y prácticas de la salud aún tengan esta mirada sobre la gordura, ya que supone un sesgo que impide que las personas sean atendidas integralmente, vulnerando sus derechos en nombre de una preocupación médica y anteponiendo el descenso de peso frente a otras necesidades de los pacientes. Este artículo, si bien intenta modestamente abrir una reflexión filosófica sobre el cuerpo, la medicina hegemónica y la enfermedad, también tiene como objetivo brindar herramientas técnicas y no técnicas para abordar la obesidad desde otro lugar. En esta primera entrega, desarrollaremos el abordaje integral de la persona con cuerpo gordo. La segunda entrega estará enfocada en los tratamientos farmacológicos, no farmacológicos y quirúrgicos de la obesidad. (AI)

Although obesity is a technical word for doctors, it implies long-term suffering in relation to their bodies for many people. Historically, traditional medicine has behaved as a barrier in caring for people with excess weight due to fatphobia and aweight-centric reductionist perspective. It is worrying that health sciences and practices still have this view of fatness, sinceit implies a bias that prevents people from being thoroughly cared for, violating their rights in the name of medical concernand putting weight loss before other patients' needs. This article modestly attempts to open a philosophical reflection about the body, hegemonic medicine, and disease, while also aiming to provide technical and non-technical tools to approach obesity. In this first part, we will explain the comprehensive approach to the person with a fat body. The second part will focus on pharmacological, non-pharmacological, and surgical treatments for obesity. (AU)

Obesidade genética não sindrômica: histórico, fisiopatologia e principais genes / Non-syndromic genetic obesity: history, pathophysiology and key genes

A obesidade é definida pelo excesso de gordura corporal acumulada no tecido adiposo quando o indivíduo atinge valores de IMC igual ou superior a 30 Kg/m2. Constitui um dos principais fatores de risco para várias doenças não transmissíveis (DNTs) como por exemplo, diabetes mellitus tipo 2 (DM2), doenças cardiovasculares, hipertensão arterial, acidente vascular cerebral e até mesmo o câncer. Embora a obesidade esteja diretamente relacionada com o consumo calórico excessivo em relação ao gasto energético diário, sua etiologia pode estar associada aos baixos níveis de atividade física, às alterações neuroendócrinas e aos fatores genéticos. Considerando o componente genético, esta pode ser classificada como sindrômicas e estar associada às alterações cromossômicas estruturais ou numéricas, ou como não sindrômica, quando relacionada, principalmente, com os polimorfismos de nucleotídeos simples (SNPs) em alelos que atuam como herança monogênica, ou ainda com a interação vários genes (poligênica multifatorial). Apesar de existirem muitas etiologias diferentes, normalmente a obesidade é tratada a partir da mesma abordagem, desconsiderando a fisiologia que a desencadeou. Dessa forma, o objetivo do presente trabalho foi abordar a obesidade genética não sindrômica por meio a) da descrição breve de perspectiva histórica sobre seu entendimento; b) da exposição dos principais mecanismos moleculares envolvidos com o controle de peso; c) da compilação dos principais genes e SNPs relacionados; d) da definição dos principais genes; e e) da abordagem das principais perspectivas de intervenção.

Obesity is defined as excess body fat accumulated in the adipose tissue when the individual reaches BMI values equal to or greater than 30 kg/m2. It is one of the main risk factors for several non-communicable diseases (NCDs), such as Type 2 Diabetes mellitus (T2D), cardiovascular diseases, high blood pressure, stroke and even cancer. Although obesity is directly related to excessive calorie intake in relation to daily energy expenditure, its etiology may be associated with low levels of physical activity, neuroendocrine changes, and genetic factors. Considering the genetic component, it can be classified as syndromic and be associated with chromosomal or numerical changes, or as non-syndromic and being related mainly to single nucleotide polymorphisms (SNPs) in alleles that act as monogenic inheritance, or with an interaction of several genes (multifactorial polygenic). Although there are many different etiologies, obesity is usually treated using the same approach, disregarding the physiology that triggered it. Thus, the aim of this study was to address non-syndromic genetic obesity through a) a brief description of a historical perspective on its understanding; b) the exposure of the main molecular mechanisms involved in weight control, c) the compilation of the key genes and related SNPs, d) the definition of the key genes and e) the approach of the main intervention representations.

Exceso de grasa visceral asociado a severidad de COVID-19, cuantificado por bioimpedancia / Excess visceral fat associated with severity of COVID-19 quantified by bioimpedance

Hay dos tipos principales de tejido adiposo; el subcutáneo, que es menos activo metabólicamente, y el tejido adiposo visceral, que secreta constantemente citocinas inflamatorias y está relacionado a enfermedades metabólicas y cardiovasculares. Nuestro objetivo fue identificar la asociación entre el exceso de grasa visceral y la severidad de enfermedad en pacientes con COVID-19. Se realizó un estudio observacional analítico que incluyó a pacientes con COVID-19 admitidos al Hospital Carrión de Huancayo, Perú. Se utilizó la balanza de bioimpedancia para cuantificar la composición corporal, la variable dependiente fue la severidad de enfermedad. Se utilizó el análisis de regresión logística para determinar la asociación de la grasa visceral y otros parámetros antropométricos con severidad de enfermedad. Se analizaron a 120 personas con COVID-19, la edad promedio fue 50 años, el sexo masculino fue 60%. De acuerdo a los valores de la composición corporal emitidos por el equipo de bioimpedancia: La grasa visceral > 15Kg (OR 7,31; p = 0,001); la grasa corporal total > 35% (OR 5,58; p = 0,009) y el exceso de peso > 20Kg (OR 6,96; p = 0,011) fueron los parámetros asociados a enfermedad severa por COVID-19. La relación positiva entre el perímetro abdominal y la cantidad de grasa visceral fue significativo (p = 0,01). En la composición corporal, el exceso de grasa visceral es el mayor parámetro asociado a enfermedad severa por COVID-19(AU)

There are two main types of adipose tissue; the subcutaneous, which is less metabolically active, and the visceral adipose tissue, which constantly secretes inflammatory cytokines and is related to metabolic and cardiovascular diseases. Our objetive was to identify the association between the excess of visceral fat and disease severity in COVID-19 patients. An analytical observational study was carried out which included patients with COVID-19 admitted to the Carrión Hospital in Huancayo, Peru. The bioimpedance balance was used to quantify the body composition; the dependent variable was the severity of the disease. A logistic regression analysis was used to determine the association of visceral fat and other anthropometric parameters with the severity of the disease. Out of 120 people with COVID-19 were analyzed, the average age was 50 years, the male sex was 60%. According to the body composition values issued by the bioimpedance team: Visceral fat> 15Kg (OR 7.31; p = 0.001); Total body fat> 35% (OR 5.58; p = 0.009) and excess weight> 20Kg (OR 6.96; p = 0.011) were the parameters associated with severe disease due to COVID-19. The positive relationship between abdominal circumference and the amount of visceral fat was significant (p = 0.01). In body composition, excess visceral fat is the main parameter associated with severe COVID-19 disease(AU)

Masticatory function according to body mass index: part I: kinematic analysis using different food textures / Función masticatoria según índice de masa corporal: parte I: análisis cinemático utilizando diferentes texturas de alimentos

Introduction: Chewing is a learned orofacial function, important in the nutrition process of most mammals. It has been described that it can vary according to the characteristics of the individuals and the characteristics of the food. The aim of this study was to compare the kinematic characteristics of mastication in subjects with different body mass index (BMI), including foods of different hardness in the analysis. Material and Methods: A cross-sectional observational study was conducted. The mastication of 3.7 g of peanut (soft food) and 3.7 g of carrot (hard food) was compared among three study groups formed according to BMI: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) and obese (BMI ≥30); each with 7 participants. The kinematics of the masticatory movement were assessed with a 3D Electromagnetic Articulograph, the characteristics analyzed were number of masticatory cycles, masticatory frequency, speed and area of the cycles. Results: No significant differences were noted among the study groups for the number of masticatory cycles, frequency or speed in the two foods studied. It was observed that when chewing carrot, the horizontal area of the masticatory cycles was significantly larger in the obese than in the overweight group. However, when chewing peanuts, this parameter did not present significant differences among the different groups. A comparison of the characteristics of mastication of the two foods revealed that the carrot chewing presented a significantly greater masticatory frequency and speed than the peanut chewing. Conclusion: This study demonstrated that food hardness influences the kinematic characteristics of mastication more than BMI, noting that hard foods are masticated faster and more frequently than soft foods and that masticatory frequency tends to increase with BMI.

Introduction: Chewing is a learned orofacial function, important in the nutrition process of most mammals. It has been described that it can vary according to the characteristics of the individuals and the characteristics of the food. The aim of this study was to compare the kinematic cha-racteristics of mastication in subjects with different body mass index (BMI), including foods of different hardness in the analysis. Material and Methods: A cross-sectional observational study was con- ducted. The mastication of 3.7 g of peanut (soft food) and 3.7 g of carrot (hard food) was compared among three study groups formed according to BMI: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) and obese (BMI ?30); each with 7 participants. The kinematics of the masticatory movement were assessed with a 3D Electromagnetic Articulograph, the characteristics analyzed were number of masticatory cycles, masticatory frequency, speed and area of the cycles. Results: No significant differences were noted among the study groups for the number of masticatory cycles, frequency or speed in the two foods studied. It was observed that when chewing carrot, the horizontal area of the masticatory cycles was significantly larger in the obese than in the overweight group. However, when chewing peanuts, this parameter did not present significant differences among the different groups. A comparison of the characteristics of mastication of the two foods revealed that the carrot chewing presented a significantly greater masticatory frequency and speed than the peanut chewing. Conclusion: This study demonstrated that food hardness influences the kinematic characteristics of mastication more than BMI, noting that hard foods are masticated faster and more frequently than soft foods and that masticatory frequency tends to increase with BMI.

Avaliação dos níveis da citocina pró-inflamatória fator de necrose tumoral-α em pacientes com diabetes tipo 2 e sua relação com variações genéticas de enzimas antioxidantes e obesidade / Evaluation of proinflammatory cytokine tumor necrosis factor-α levels in obese vs nonobese patients with type 2 diabetes and their relationship to CAT C-262T polymorphism

Introdução: Diabetes tipo 2 (DM2) é um distúrbio multifatorial caracterizado pelo aumento dos níveis de radicais livres. Tanto o estresse oxidativo quanto a obesidade contribuem para um estado inflamatório da doença, principalmente pelo aumento da citocina TNF-α. Sabendo-se que a genética individual pode contribuir para o estresse oxidativo, o estudo avaliou o impacto das variações genéticas de enzimas antioxidantes C262T no gene CAT e polimorfismos nulos dos genes GSTM1 e GSTT1 nos níveis de TNF-α, assim como, avaliou se as variantes genéticas atuariam sinergicamente com a obesidade aumentando os níveis da citocina em diabéticos da Grande Vitória/ES, Brasil.Métodos: O polimorfismo no gene CAT foi avaliado pela técnica PCR/RFLP e nos genes GSTM1 e GSTT1 por PCR multiplex, em 56 pacientes, sendo 28 obesos e 28 não obesos. Níveis de TNF-α foram medidos pela técnica de ELISA sanduíche.Resultados: Frequências das variantes nulas de GSTM1 e GSTT1 foram 44,6% e 17,9%, respectivamente. As frequências genotípicas C262T-CAT foram 73,2%, 25% e 1,8% para homozigoto normal, heterozigoto e homozigoto polimórfico, respectivamente. Não houve associação entre genótipos polimórficos e aumento dos níveis de TNF-α, assim como, não foi demonstrado aumento significante da citocina quando avaliado o sinergismo entre obesidade e genética individual do paciente.Conclusão: Níveis de TNF-α não se elevam em diabéticos tipo 2 na presença dos polimorfismos nos genes CAT, GSTM1 e GSTT1, e a obesidade não atua no aumento dessa citocina na população estudada, separadamente ou em conjunto com a genética individual de variantes nos genes CAT, GSTM1 e GSTT1.

Introduction: Type 2 diabetes is a multifactorial disorder characterized by increased levels of free radicals. Both oxidative stress and obesity contribute to an inflammatory state of the disease, mainly by increasing the levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α). Considering that personal genetics may contribute to oxidative stress, this study assessed the impact of CAT C-262T polymorphism and GSTM1 and GSTT1 null polymorphisms on TNF-α levels in patients with type 2. diabetes. The study also evaluated whether the genetic variants act synergistically with obesity to increase TNF-α levels in patients with diabetes from Grande Vitória, Brazil.Methods: Fifty-six patients were included, of whom 28 were obese and 28 were nonobese. The CAT gene polymorphism was assessed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, whereas GSTM1 and GSTT1 polymorphisms were assessed using multiplex PCR. TNF-α levels were measured using the sandwich ELISA technique.Results: Frequencies of GSTM1 and GSTT1 null polymorphisms were 44.6% and 17.9%, respectively. The genotype frequencies of CATC-262T polymorphism were 73.2%, 25.0%, and 1.8% for normal homozygote, heterozygote, and polymorphic homozygote, respectively. Polymorphic genotypes were not associated with increased TNF-α levels, and there was no significant increase in TNF-α levels when evaluating the synergism between obesity and personal genetics.Conclusion: The presence of CAT, GSTM1, and GSTT1 gene polymorphisms was not associated with increased TNF-α levels in patients with type 2 diabetes. Obesity alone or combined with personal genetics of CAT, GSTM1, and GSTT1gene polymorphisms did not promote increased TNF-α levels in the study population.

Acute whole-body electromyostimulation associated with dynamic exercises did not alter cardiac autonomic modulation and oxygen uptake in obese and eutrophic men

Abstract Aim: To contrast the acute effects of whole-body electromyostimulation (WB-EMS) with sham associated with dynamic exercises on cardiovascular, ventilatory, metabolic, and autonomic responses in men with obesity and controls. Methods: A randomized cross-over and double-blind trial with nine eutrophic (23.6 years; 23 ± 1.4 kg/m2) and ten men with obesity (26 ± 4 years; 38 ± 7 kg/m2), who were randomized to receive WB-EMS-Sham or Sham-WB-EMS with 30 min of rest between protocols. WB-EMS protocol (Miha Bodytec®) was applied at the motor level, frequency = 85 Hz, pulse duration = 350 μs, cycle on = 6′; cycle off = 4′. Sham group performed the same exercises with the electric current turned off. Throughout both protocols, subjects executed two dynamic exercises of 5 minutes each (step-up and step down associated with shoulder flexion, and lunge exercise associated with elbow flexion) in the same order. R-R intervals and breath-by-breath respiratory gases analysis were collected during the protocols. Heart rate variability (HRV) indexes were obtained using linear and nonlinear analysis. The level of statistical significance was set at p < 0.05. Results: Regarding both exercises, participants with obesity presented reduced oxygen uptake, higher ventilation, respiratory rate, blood pressure, and Borg scores (p < 0.05) when contrasted with controls, as expected. However, no significant differences were found for HRV indexes between groups (p > 0.05). In addition, WB-EMS did not increase oxygen uptake or altered autonomic modulation when contrasted with sham in both groups (p < 0.05). Conclusion: Obesity has a negative impact on symptoms and functional capacity. However, WB-EMS did not acutely enhance oxygen uptake or HRV during exercise in a population with obesity.

Patients with Post-Covid-19 Syndrome are at risk of malnutrition and obesity: findings of outpatient follow-up / Pacientes com Síndrome Pós-Covid-19 apresentam risco de desnutrição e obesidade: achados de um ambulatório de seguimento

ABSTRACT Objective To evaluate the nutritional and functional status, swallowing disorders, and musculoskeletal manifestations of patients with Post-Covid-19 Syndrome, stratified by the Appendicular Skeletal Muscle Mass Index. Methods This is a cross-sectional study with patients diagnosed with Post-Covid-19 Syndrome after discharge from the intensive care unit of a university hospital. The evaluated outcomes were: nutritional status (Mini Nutritional Assessment, bioimpedance and anthropometry), swallowing disorders (Dysphagia Risk Evaluation Protocol), functional status (Post-Covid-19 Functional Status Scale), and musculoskeletal manifestations. According to the Appendicular Skeletal Muscle Mass Index, patients were stratified in terms of loss or not loss of muscle mass. Results Thirty-eight patients were included in the study, 20 stratified into the no loss of muscle mass group (17 females; 49.45±12.67 years) and 18 into the loss of muscle mass group (18 males; 61.89±12.49 years). Both groups were at risk of malnutrition (Mini Nutritional Assessment scores between 17-23.5 points; No Loss of Muscle Mass Group: 21.82±3.93; Loss of Muscle Mass Group: 23.33±3.41) and obesity (No Loss of Muscle Mass Group: 33.76±6.34; Loss of Muscle Mass Group: 30.23±3.66). The groups differed in terms of bioimpedance parameters (except fat mass) and age. However, there were no differences in swallowing alterations, functional status, and musculoskeletal manifestations. Conclusion Patients with Post-Covid-19 Syndrome, stratified according to the Appendicular Skeletal Muscle Mass Index, were at risk of malnutrition and obesity. The persistence of fatigue, weakness, myalgia and arthralgia at 6 months after hospital discharge is noteworthy. These findings emphasize the importance of comprehensive care for patients with Post-Covid-19 Syndrome.

RESUMO Objetivo Avaliar o estado nutricional, status funcional, alterações de deglutição e manifestações musculoesqueléticas de pacientes com Síndrome Pós-Covid-19, estratificados pelo Índice de Massa Muscular Esquelética Apendicular. Métodos Estudo transversal composto por pacientes diagnosticados com a Síndrome Pós-Covid-19 que estiveram internados na Unidade de Terapia Intensiva de um hospital universitário. Os desfechos avaliados foram: estado nutricional (Mini Avaliação Nutricional; bioimpedância e antropometria), alterações de deglutição (Protocolo Fonoaudiológico de Avaliação do Risco de Disfagia), status funcional (Post-Covid-19 Functional Status Scale) e manifestações musculoesqueléticas. Os pacientes foram classificados, quanto à perda de massa muscular conforme o Índice de Massa Muscular Esquelética Apendicular, em grupo sem e com perda de massa muscular. Resultados Foram inseridos no estudo 38 pacientes, 20 no grupo sem perda de massa muscular (17 deles do sexo feminino; 49,45±12,67 anos) e 18 no grupo com perda de massa muscular (todos do sexo masculino; 61,89±12,49 anos). Os pacientes de ambos os grupos apresentaram risco de desnutrição (escores Mini Avaliação Nutricional entre 17-23.5 pontos; Grupo Sem Perda de Massa Muscular: 21,82±3,93; Grupo Com Perda de Massa Muscular: 23,33±3,41) e obesidade (Grupo Sem Perda de Massa Muscular: 33,76±6,34; Grupo Com Perda de Massa Muscular: 30,23±3,66). Os grupos diferiram quanto aos parâmetros da bioimpedância (exceto massa gorda) e idade. Entretanto, não foram observadas diferenças na deglutição, status funcional e manifestações musculoesqueléticas. Conclusão Os pacientes com Síndrome Pós-Covid-19, estratificados conforme o Índice de Massa Muscular Esquelética Apendicular, apresentaram risco de desnutrição e obesidade. Destaca-se a persistência de fadiga, fraqueza, mialgia e artralgia após seis meses da alta hospitalar. Esses achados ressaltam a importância do cuidado integral ao paciente com a Síndrome Pós-Covid-19.

Food consumption, anthropometry and body composition of patients diagnosed with Parkinson's disease / Consumo alimentar, antropometria e composição corporal de pacientes diagnosticados com doença de Parkinson

ABSTRACT Objective The aim of the present study was to evaluate the consumption of risk and protective foods for chronic noncommunicable diseases and to investigate associations with anthropometric parameters and body composition in individuals with Parkinson's disease. Methods A case-series study was conducted with 79 adult and elderly patients of both genders in outpatient care. Food intake was evaluated using a food frequency questionnaire for the identification of foods with greater daily consumption, stratified by gender. The consumption frequency of each food was converted into scores of two food groups characteristics: risk and protection. The conceptual model took into account sociodemographic, behavioral and anthropometric variables as well as body composition. Results A total of 72.1% of the participants in the sample had excess weight based on the body mass index and 43.5% had excess body fat. The consumption of protective foods was greater among individuals with a higher body mass index and with a greater rate of body fat. Conclusion The data indicate a situation of reverse causality and reveal the complexity of the relationship among food intake, body fat and chronic noncommunicable diseases.

RESUMO Objetivo Este estudo visou avaliar o consumo de alimentos de risco e proteção para as doenças crônicas não transmissíveis e sua associação com parâmetros antropométricos e de composição corporal em pacientes com doença de Parkinson. Métodos Estudo do tipo série de casos, com 79 pacientes adultos e idosos, de ambos os sexos, atendidos ambulatorialmente. O consumo alimentar desses pacientes foi avaliado por um questionário de frequência alimentar, sendo identificados inicialmente os alimentos com maior frequência de consumo diário por sexo e, em seguida, a frequência de consumo de cada alimento foi convertida em escores, sendo constituídos dois grupos de alimentos: risco e proteção. O modelo conceitual considerou variáveis sociodemográficas, comportamentais, antropométricas e de composição corporal. Resultados Ao todo, 72,1% dos pacientes apresentaram excesso de peso segundo o índice de massa corporal e 43,5% apresentaram excesso de gordura corporal. O consumo de alimentos protetores foi maior nos pacientes com maior índice de massa corporal e maior percentual de gordura corporal. Conclusão Os dados apontam para uma condição de causalidade reversa e revelam a complexidade envolvida na relação entre consumo alimentar, gordura corporal e doenças crônicas não transmissíveis.

Alteraciones de la función pulmonar medida por espirometría y oscilometría de impulso en niños asmáticos con sobrepeso y obesidad / Alterations in lung function as measured by spirometry and impulse oscillometry in asthmatic children with overweight and obesity

INTRODUCCIÓN: El incremento del índice de masa corporal afecta la función pulmonar en el asma. Objetivo: determinar si existen diferencias entre asmáticos con estado nutricional normal, sobrepeso y obesidad en cuanto a alteraciones de la oscilometría de impulso (IOS) y espirometría. MÉTODO: Estudio realizado en niños y adolescentes con asma persistente. Se practicó sucesivamente IOS y Espirometría pre y post- broncodilatador según criterios ATS/ERS/SER. Los pacientes se clasificaron en: eutróficos (AE), con sobrepeso (ASP) y obesos (AO). Se compararon promedios de valores basales y con respuesta broncodilatadora (RB) en espirometría e IOS, con análisis de varianzas ANOVA y test de Tukey post hoc. Se consideró un poder de 80% y error α de 5%. RESULTADOS: Se analizaron 559 pacientes, promedio de edad 9,2 años, 50,9% varones. AE 52,4%, ASP 31,3% y AO 16,3%. Se encontraron diferencias significativas entre AO vs AE (X5, AX, D5-20, VEF1/CVF, FEF25-75/CVF, RB VEF1), y entre ASP vs AE (AX, D5-20, VEF1/CVF). También se encontraron diferencias significativas en varones, no encontradas en las mujeres (X5, D5-20, VEF1/CVF, RB CVF, RB VEF1). CONCLUSIONES: Los niños asmáticos con sobrepeso y obesidad, tienen un mayor compromiso de los índices de función pulmonar medida por espirometría e IOS que los asmáticos con estado nutricional normal. Existen diferencias de género en las alteraciones espirometría e IOS.

INTRODUCTION: Increased body mass index asthma affects lung function in asthma. Objective: to determine if asthmatics with overweight or obesity have alterations in Impulse oscillometry (IOS) and spirometry compared to eutrophic METHOD: Study carried out in children and adolescents with persistent asthma. IOS-Spirometry pre and post bronchodilator were performed successively according to ATS/ERS/SER criteria. The patients were classified as: eutrophic (AE), overweight (ASP) and obese (OA). Baseline and bronchodilator response (BR) averages were compared in spirometry and IOS with ANOVA and Tukey's post hoc analysis of variance. A power of 80% and α error of 5% were considered. RESULTS: 559 patients were analyzed, mean age 9.2 years, 50.9% male. AE 52.4%, ASP 31.3% and OA 16.3%. Significant differences were found between OA vs AE (X5, AX, D5-20, FEV1/FVC, FEF25-75 / FVC, RB FEV1), and between ASP vs AE (AX, D5-20, FEV1/FVC). Significant differences were also found in men, not women (X5, D5-20, FEV1/FVC, BR FVC, BR FEV1). CONCLUSIONS: Asthmatic children with overweight and obesity have a greater compromise of pulmonary function parameters measured by spirometry and IOS than asthmatics with normal nutritional status. There are gender differences in spirometry and IOS alterations.

Mortalidad por COVID-19 en México y las enfermedades metabólicas durante el año crítico de la pandemia / COVID-19 mortality in Mexico and metabolic diseases during a critical pandemic year

Conocer la asociación específica de las enfermedades metabólicas en la mortalidad por COVID-19, ocurrida en México durante el año crítico de la pandemia de marzo 2020 a marzo 2021. Método. Se utilizó la base nacional de COVID-19 de la Dirección General de Epidemiología. Se analizaron los casos positivos que presentaron las enfermedades metabólicas: cardiovasculares, hipertensión, diabetes y obesidad. Se realizó un análisis descriptivo para conocer la distribución de los casos fallecidos y no fallecidos. Se empleó la prueba de ji cuadrada para la diferencia de las proporciones. Se utilizaron análisis de regresión logística para conocer la asociación entre las enfermedades metabólicas y la mortalidad por COVID-19 en personas positivas al virus SARS-CoV-2. Los datos fueron ajustados por edad y sexo. Resultados. Se observó la asociación de las enfermedades metabólicas en la mortalidad. La diabetes tuvo mayor porcentaje de letalidad 18,4%. Cuando se conjuntaron las enfermedades cardiovasculares y diabetes el porcentaje de letalidad subió a 31,5%; la conjunción de las enfermedades cardiovasculares, con hipertensión y diabetes fue la de mayor porcentaje de letalidad 38,7%. La obesidad fue la que tuvo menor incidencia. Conclusiones. Las enfermedades metabólicas en México son un problema de salud pública que afectó la mortalidad por covid-19. Es prioritario atender con políticas públicas preventivas y efectivas en favor de un modelo de consumo alimentario sano, acorde con las necesidades nutrimentales de la población(AU)

To know the specific association of metabolic disease on COVID-19 mortality, occurred during the critical year of the pandemic, from march 2020 to march 2021. Method: The Covid-19 national base of the General Directorate of Epidemiology was used. Positive cases of metabolic diseases were analyzed: cardiovascular disease, hypertension, diabetes and obesity. A descriptive analysis was carried out to find out the distribution of deceased and non-deceased cases. The chi-square test was used for the difference in proportions. Logistic regression analysis was used to understand the association between metabolic diseases and COVID 19 mortality in people who tested positive for the SARS-CoV-2 virus. The data were adjusted for age and gender. Results: The association of metabolic diseases on mortality was observed. Diabetes had a higher percentage of lethality 18,4%. When cardiovascular disease and diabetes were combined, the fatality rate rose to 31,5%; the combination of cardiovascular diseases, with hypertension and diabetes was the highest percentage of lethality 38,7%. Obesity had the least incidence. Conclusions: Metabolic diseases in México are a public health problem that affected COVID-19 mortality. It is a priority to deal with preventive and effective public policies in favor of a healthy food consumption model, in line with the nutritional needs of the population(AU)

Aspectos generales sobre la diabesidad: fisiopatología y tratamiento / General aspects of diabesity: physiopathology and treatment

Introducción: La estrecha relación que existe entre diabetes mellitus tipo 2 y obesidad ha dado lugar a la creación del término "diabesidad", considerándose la nueva enfermedad del siglo XXI. La dupla entre estas produce grave lesión en el tejido hepático, músculo esquelético y sistema cardiovascular. Es importante un estilo de vida saludable y buena adherencia farmacológica para combatir esta pandemia. Objetivo: Describir aspectos generales acerca de la fisiopatología y el tratamiento de la diabesidad. Método: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos Science Direct, EMBASE, LILACS, Redalyc, SciELO y PubMed. Los criterios de inclusión fueron publicaciones en inglés y español, en las que el título, palabras clave o resumen incluyen información pertinente al objetivo de estudio, periodicidad no mayor de cinco años. En la búsqueda se obtuvieron 50 artículos, de los cuales fueron seleccionados 35. Conclusión: La insulinorresistencia es el factor determinante para la progresión hacia diabetes mellitus tipo 2, en calidad de respuesta del tejido adiposo frente a altos niveles de ácidos grasos libres (lipotoxicidad), consecuencia de la obesidad, obligando al páncreas a secretar grandes cantidades de insulina, que con el tiempo compromete su funcionalidad. En la actualidad, existen diversas alternativas no farmacológicas, farmacológicas y quirúrgicas para el abordaje de la diabesidad, donde la prevención representa un aspecto de vital importancia(AU)

Introduction: The close relation among diabetes mellitus type 2 and obesity has led to the creation of the term "diabesity," considering it the new disease of XXI century. The fusion of these two diseases produces severe lesions in the hepatic tissue, the skeletal muscle and the cardiovascular system. It is important a healthy lifestyle and a good pharmacological adherence to fight this so called pandemic. Objective: Describe general aspects related to the physiopathology and treatment of diabesity. Method: It was carried out a non-systematic bibliographic search in databases like Science Direct, EMBASE, LILACS, Redalyc, SciELO and PubMed. The inclusion criteria were publications in English and Spanish language, with a periodicity of no more than 5 years, in which the title, keywords and abstract included information that will be relevant for the objective of the study. In the search 50 articles were found, of which 35 were selected. Conclusions: Insulin resistance is the key factor for the progression towards diabetes mellitus type 2, as a response of the adipose tissue to high levels of free fatty acids (lipotoxicity), which is a consequence of obesity, and obligates the pancreas to secrete big amounts of insulin that as time goes by compromises its functionality. Nowadays, there are different non-pharmacological, pharmacological and surgical alternatives to address the diabesity, in which prevention represents an aspect of vital importance(AU)

Deterioro del intercambio gaseoso en sujetos con incremento del índice de masa corporal a una altitud de 2, 240 metros sobre el nivel del mar / Deterioration of gas exchange in subjects with an increase in body mass index at an altitude of 2, 240 meters above sea level

Resumen Introducción: Las alteraciones del intercambio gaseoso se han reconocido en la obesidad mórbida; sin embargo, no se conoce su comportamiento conforme se incrementa el índice de masa corporal. Objetivo: Conocer el comportamiento del intercambio gaseoso a la altura de la Ciudad de México en el desarrollo de obesidad mórbida. Métodos: Mediante un diseño transversal analítico se estudió a sujetos pareados por género y edad de cuatro grupos diferentes de índice de masa corporal (kg/m2): normal (18.5-24.9), sobrepeso (25-29.9), obesidad (30-39.9) y obesidad mórbida (≥ 40). Se obtuvieron sus antecedentes patológicos y demográficos, variables de gasometría arterial y espirometría simple. Las variables se determinaron de acuerdo con las características de la muestra; las diferencias entre grupos se realizaron mediante Anova de una vía con ajuste de Bonferroni, así como la correlación de Pearson para las variables relacionadas. Una p < 0.05 se consideró con significación estadística. Resultados: Se estudió a 560 pacientes en cuatro grupos. La edad promedio fue de 49 ± 11 años. La mayor frecuencia de diabetes mellitus (34.29%), hipertensión arterial (50%) e hiperlipidemia (36.43%) se registró en el grupo de obesidad, y la de roncador (73.57%) en la obesidad mórbida. Se identificaron diferencias desde el grupo normal respecto de la obesidad mórbida: PaCO2 31.37 ± 2.08 vs. 38.14 ± 5.10 mmHg; PaO2 68.28 ± 6.06 vs. 59.86 ± 9.28 mmHg y SaO2 93.51 ± 1.93 vs. 89.71 ± 5.37%, todas con p = 0.0001. Correlación IMC-PaCO2: 0.497, e IMC-PaO2: -0.365, p = 0.0001, respectivamente. Conclusiones: A la altitud de la Ciudad de México y con índice de masa corporal > 30 kg/m2, las variables relacionadas con el intercambio gaseoso y espirometría simple comienzan a deteriorarse; son evidentes con IMC > 40 kg/m2.

Abstract Introduction: Alterations of gas exchange have been recognized in morbid obesity, however, it is not known how their behavior would be as the body mass index increases. Objective: To know the behavior of gas exchange at the level of Mexico City in the development of morbid obesity. Methods: Through analytical design, subjects matched by gender and age were studied from four different groups of body mass index (kg/m2), normal (18.5-24.9), overweight (25-29.9), obesity (30-39.9) and morbid obesity (≥ 40). Their pathological and demographic antecedents, arterial blood gas and simple spirometry variables were obtained. The variables were shown according to their sample characteristic. The differences between groups were made using one way Anova with Bonferroni adjustment, as well as Pearson’s correlation for the related variables. Statistical significance was considered with p < 0.05. Results: 560 subjects were studied in 4 groups. The average age 49 ± 11 years old. The highest frequency of diabetes mellitus (34.29%), arterial hypertension (50%) and hiperlipidemia (36.43%) was in the obesity group, and being snoring (73.57%) in morbid obesity. There were differences from the normal group versus. morbid obesity: PaCO2 31.37 ± 2.08 versus. 38.14 ± 5.10 mmHg; PaO2 68.28 ± 6.06 versus. 59.86 ± 9.28 mmHg and SaO2 93.51 ± 1.93 versus. 89.71 ± 5.37%, all with p = 0.0001. The IMC-PaCO2 correlation: 0.497, and IMC-PaO2: −0.365, p = 0.0001 respectively. Conclusions: At the altitude of Mexico City and body mass index > 30 kg/m2 the variables related to gas exchange and simple spirometry begin to deteriorate; are evident with BMI > 40 kg/m2.

Gestational diabetes mellitus and obesity are related to persistent hyperglycemia in the postpartum period / Diabetes mellitus gestacional e obesidade estão relacionados à hiperglicemia persistente no período pós-parto

Abstract Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6-12 weeks postpartum). Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi- Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%. Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period. Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.

Resumo Objetivo Avaliar características sociodemográficas e obstétricas de mulheres com diabetes gestacional que mantêm hiperglicemia no período pós-parto (6-12 semanas pós-parto). Métodos Este é um estudo longitudinal de coorte com mulheres com diagnóstico de diabetes gestacional e/ou macrossomia fetal entre 1° de março de 2016 a 1° de março de 2017. As mulheres coletaram glicemia de jejum, teste de tolerância a glicose e hemoglobina glicada entre 6 a 12 semanas pós-parto. Os dados foram coletados de prontuários médicos e durante entrevista na primeira consulta de revisão pós-parto. Uma análise estatística foi realizada através do cálculo de frequências, porcentagens, teste do qui-quadrado, teste exato de Fisher, teste de Mann-Whitney e regressão multivariada de Poisson. A significância estatística adotada foi de 5%. Resultados Cento e vinte e duas mulheres foram incluídas. A maioria delas tinha menos de 35 anos de idade (70,5%), eram brancas, multíparas, e não tinham história de diabetes gestacional. Treze por cento das participantes desenvolveu hiperglicemia persistente. A análise univariada mostrou que os fatores relacionados com a persistência de hiperglicemia no período pós-natal foram: idade materna acima de 35 anos, sobrepeso, obesidade grau 1 e ganho de peso abaixo de 5 quilos. A análisemultivariada incluiu o diagnóstico no primeiro trimestre como fator de risco para hiperglicemia persistente. Conclusão Mulheres acima de 35 anos, obesidade, sobrepeso e diagnóstico de diabetes gestacional no primeiro trimestre estão relacionados com hiperglicemia persistente no período pós-parto.

Obesidad y piel / Obesity and skin

Introduction: Obesity is a growing global health problem; it may even be one of the worst public health issues. In Chile, 34.4% of the population is obese, therefore, is it important for clinicians to be aware of all the consequences of obesity. In this review, we will address the relation of four main dermatologic conditions with obesity: psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma. Material and methods: Search in pubmed for obesity and psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma. Results: Obesity has a direct impact in the prevalence and severity of psoriasis, hidradenitis suppurativa, acanthosis nigricans. The reduction on body weight has proven to reduce severity of psoriasis and hidradenitis suppurativa. Obese patients with psoriasis have a higher risk on adverse effects due to medication and less effectiveness of biological medications. Acanthosis nigricans is a clinical indicator of insulin resistance and a risk predictor for those with greater risk to develop diabetes in the future. The relationship between obesity and malignant melanoma is not clear and needs further research. Conclusion: Obesity is increasing, dermatologist will face this condition more frequently, it has a great impact over psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma, thus it should be considered in treatment decisions. (AU)

Obesidad como factor de riesgo para infección por COVID-19: obesidad y COVID-19 / Obesity as a risk factor for COVID-19 infection

La obesidad es una enfermedad que se ha visto relacionada con la pandemia del nuevo coronavirus, sugiriendo que los obesos tienen mayor riesgo a padecer COVID-19 grave y sus complicaciones, cobrando mayor relevancia en Chile, país con tasas elevadas de obesidad. Se revisan mecanismos fisiopatológicos involucrados, efecto de las comorbilidades, posibilidad de atención médica y resultados de una eventual vacunación, corroborando un peor pronóstico para este grupo de pacientes. Se destaca la necesidad de datos antropométricos específicos, además del índice de masa corporal (IMC) para establecer una relación más relevante. La paradoja de la obesidad, de igual manera, carece de evidencias para asociarse al COVID-19.

Obesity is a disease that has been related to the new coronavirus pandemic, suggesting that obese people have a greater risk of suffering from severe COVID-19 and its complications, becoming more relevant in Chile, a country with high rates of obesity. The pathophysiological mechanisms involved, effect of comorbidities, medical care atention and potential vaccination, outcomes are reviewed, showing a worse prognosis for this group of patients. The need for specific anthropometric data is highlighted, in addition to the body mass index (BMI) to establish a more relevant relationship. Likewise, the obesity paradox, lacks of evidence to be associated with COVID-19.

COVID-19 and obesity in childhood and adolescence: a clinical review / COVID-19 e obesidade na infância e adolescência: uma revisão clínica

Abstract Objective: To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. Sources: Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. Summary of findings: Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. Conclusions: The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

Resumo Objetivo: Identificar fatores que contribuem para o aumento da suscetibilidade e gravidade da COVID-19 em crianças e adolescentes obesos e suas consequências para a saúde. Fontes de dados: Estudos publicados entre 2000 e 2020 nas bases de dados PubMed, Medline, Scopus, SciELO e Cochrane. Síntese dos dados: A obesidade é uma comorbidade altamente prevalente em casos graves de COVID-19 em crianças e adolescentes e o isolamento social pode levar ao aumento do acúmulo de gordura. Tecido adiposo excessivo, déficit de massa magra, resistência à insulina, dislipidemia, hipertensão, altos níveis de citocinas pró-inflamatórias e baixa ingestão de nutrientes essenciais são fatores que comprometem o funcionamento dos órgãos e sistemas no indivíduo obeso. Esses fatores estão associados a danos nos sistemas imunológico, cardiovascular, respiratório e urinário, juntamente com a modificação da microbiota intestinal (disbiose). Na infecção por SARS-CoV-2, essas alterações orgânicas causadas pela obesidade podem aumentar a necessidade de assistência ventilatória, risco de tromboembolismo, taxa de filtração glomerular reduzida, alterações na resposta imune inata e adaptativa e perpetuação da resposta inflamatória crônica. Conclusões: A necessidade de isolamento social pode ter o efeito de causar ou agravar a obesidade e suas comorbidades e pediatras precisam estar cientes desse problema. Diante de crianças com suspeita ou confirmação de COVID-19, os profissionais de saúde devem 1) diagnosticar o excesso de peso; 2) aconselhar sobre cuidados de saúde em tempos de isolamento; 3) fazer a triagem de comorbidades, garantindo que o tratamento não seja interrompido; 4) medir os níveis de imunonutrientes; 5) orientar a família respeitando as especificidades da situação; e 6) encaminhamento a unidades qualificadas para cuidar de crianças e adolescentes obesos, quando necessário.

Relación de la grasa corporal con la alimentación emocional y calidad de la dieta en universitarios de México / Relationship of body fat with emotional eating and quality of diet in university students from Mexico

La obesidad es un problema de salud pública. La comprensión de factores tanto emocionales como dietéticos relacionados a su desarrollo es fundamentales para abordar este problema. El objetivo del presente estudio fue analizar por sexo y edad la relación de la grasa corporal con la alimentación emocional (AE) y la calidad de la dieta (CD) en población universitaria. Se realizó un estudio transversal en el que participaron 367 estudiantes universitarios de medicina (65 % mujeres). El porcentaje de grasa se midió a través de bioimpedancia eléctrica. La alimentación emocional (AE) (emoción, familia, indiferencia, cultura y efecto del alimento) se obtuvo de la escala de AE y la calidad de la dieta (CD)a partir de índice de calidad de la dieta mexicana (ICMX) (suficiente, balanceada, completa, variada e inocua), mediante un cuestionario semicuantitativo de frecuencia de consumo de alimentos. Para identificar qué variables independientes explican el porcentaje de grasa corporal se utilizó la regresión lineal múltiple. Se encontraron diferencias estadísticamente significativas entre sexos, los hombres presentaron valores superiores a las mujeres en edad, peso, altura e IMC (kg/m2), mientras que las mujeres presentaron un mayor porcentaje de grasa corporal respecto a los hombres. La cultura (p=,001) y efecto del alimento (p=,006), factores de la AE, predijeron menor porcentaje de grasa corporal en hombres mayores de 20 años. Resulta necesario implementar programas de salud, que vayan encaminados a un consumo saludable de alimentos mediante actividades recreativas y con el acompañamiento de profesionales de la salud durante la universidad(AU)

Obesity is a public health problem. Understanding both emotional and dietary factors related to its development are essential to address this problem. The objective of this study was to analyze by sex and age the relationship of body fat with emotional eating (EE) and diet quality (DQ) in university population. A cross-sectional study was carried out in which 367 university medical students participated (65% women). Body fat percentage was measured through electrical bioimpedance. Emotional eating (EE) (emotion, family, indifference, culture and effect of food) was obtained from the EE scale and diet quality (DQ) from the Mexican Diet Quality Index (MDQI) (sufficient, balanced, complete, varied and innocuous), using a semi-quantitative food consumption frequency questionnaire. Multiple linear regression was used to identify which independent variables explain body fat percentage. Statistically significant differences were found between sexes, men had higher values than women in age, weight, height, and BMI (kg/m2), while women had a higher body fat percentage compared to men. Culture (p = .001) and effect of food (p = .006), factors of EE, predicted lower body fat percentage in men older than 20 years. It is necessary to implement health programs that are aimed at a healthy consumption of food through recreational activities and with the accompaniment of health professionals during university(AU)

Impact of Grade I obesity on respiratory mechanics during video laparoscopic surgery: prospective longitudinal study / Impacto da obesidade Grau I na mecânica respiratória durante cirurgia videolaparoscópica: estudo longitudinal prospectivo

Abstract Introduction and objectives: The association pneumoperitoneum and obesity in video laparoscopy can contribute to pulmonary complications, but has not been well defined in specific groups of obese individuals. We assessed the effects of pneumoperitoneum in respiratory mechanics in Grade I obese compared to non-obese. Methods: Prospective study including 20 patients submitted to video laparoscopic cholecystectomy, normal spirometry, divided into non-obese (BMI ≤ 25 kg.m-2) and obese (BMI > 30 kg.mg-2), excluding Grade II and III obese. We measured pulmonary ventilation mechanics data before pneumoperitoneum (baseline), and five, fifteen and thirty minutes after peritoneal insufflation, and fifteen minutes after disinflation (final). Results: Mean BMI of non-obese was 22.72 ± 1.43 kg.m-2 and of the obese 31.78 ± 1.09 kg.m-2, p < 0.01. Duration of anesthesia and of peritoneal insufflation was similar between groups. Baseline pulmonary compliance (Crs) of the obese (38.3 ± 8.3 mL.cm H2O-1) was lower than of the non-obese (47.4 ± 5.7 mL.cm H2O-1), p = 0.01. After insufflation, Crs decreased in both groups and remained even lower in the obese at all moments assessed (GLM p < 0.01). Respiratory system peak pressure and plateau pressure were higher in the obese, albeit variations were similar at moments analyzed (GLM p > 0.05). The same occurred with elastic pressure, higher in the obese at all times (GLM p = 0.04), and resistive pressure showed differences in variations between groups during pneumoperitoneum (GLM p = 0,05). Conclusions: Grade I obese presented more changes in pulmonary mechanics than the non-obese during video laparoscopies and the fact requires mechanical ventilation-related care.

Resumo Justificativa e objetivos: Em videolaparoscopias, a associação de pneumoperitônio e obesidade pode contribuir para complicações pulmonares, mas não está bem definida em grupos específicos de obesos. Avaliamos os efeitos do pneumoperitônio na mecânica respiratória dos obesos Grau I em comparação aos não obesos. Métodos: Estudo prospectivo envolvendo 20 pacientes submetidos à colecistectomia videolaparoscópica, com espirometria normal, separados em não-obesos (IMC ≤ 25 kg.m-2) e obesos (IMC > 30 kg.mg-2), excluídos obesos Grau II e III. Mensuramos dados da mecânica ventilatória pulmonar antes do pneumoperitônio basal, após cinco, quinze e trinta minutos da insuflação peritoneal e quinze minutos após a desinsuflação final. Resultados: O IMC médio dos não obesos foi de 22,72 ± 1,43 kg.m-2 e dos obesos 31,78 ± 1,09 kg.m-2, p < 0,01. A duração da anestesia e da insuflação peritoneal foram semelhantes entre os grupos. A complacência pulmonar (Crs) basal dos obesos (38,3 ± 8,3 mL.cm H2O-1) foi inferior aos não obesos (47,4 ± 5,7 mL.cm H2O-1), p = 0,01. Após a insuflação, a Crs diminuiu nos dois grupos e permaneceu ainda mais baixa nos obesos em todos os momentos avaliados (GLM p < 0,01). A pressão de pico e a pressão de platô do sistema respiratório foram mais elevadas nos obesos, mas apresentaram semelhantes variações nos momentos analisados (GLM p > 0,05). O mesmo ocorreu com a pressão elástica, mais elevada nos obesos em todos tempos (GLM p = 0,04), e a pressão resistiva apresentou diferenças nas variações entre os grupos durante o pneumoperitônio (GLM p = 0,05). Conclusão: Obesos Grau I apresentam maiores alterações na mecânica pulmonar que os não obesos em videolaparoscopias e este fato recomenda cuidados relacionados a ventilação mecânica.