Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Evaluación integral del paciente con obesidad candidato a cirugía bariátrica­endócrino metabólica / Comprehensive evaluation of the patient with obesity who is a candidate for metabolic bariatric-endocrine surgery

En la actualidad, la obesidad es conside-rada una pandemia, cuya incidencia se ha triplicado en los últimos 30 años, y ha ge-nerado problemas de salud pública cada vez mayores. Tomando como base las guías de la Asociación Americana de Endocrinólogos (AACE), la Sociedad para la Obesidad, la Sociedad Americana de Cirugía Bariátrica y Metabólica (ASMBS), la Asociación para Medicina de la Obe-sidad y la Asociación Americana de Anes-tesiólogos, se realiza el presente docu-mento, con el fin de que se constituya en la hoja de ruta que guíe el procedimiento a seguir en los pacientes que padecen de esta enfermedad crónica y que acuden al Hospital General San Francisco (HGSF)1. La obesidad se caracteriza por el uso de varios medicamentos debido a las co-morbilidades relacionadas: enfermedad cardiovascular, diabetes mellitus tipo 2, enfermedad renal crónica, hígado graso no alcohólico, síndrome metabólico y varios tipos de cánceres2. Este protocolo contiene el más alto nivel de evidencia disponible hasta la fecha, en relación al manejo quirúrgico y no quirúrgico del paciente con diagnóstico de obesidad, incluyendo temas como la identificación de los pacientes candidatos para los pro-cedimientos bariátricos, tipo de proce-dimientos que deberían ser ofertados, el manejo preoperatorio, transoperatorio y el cuidado post operatorio de seguimiento2-4.Desde la publicación por parte de la Ame-rican Society for Metabolic and Bariatric Surgery (ASMBS) en el año 2013 de las guías de manejo del paciente con obe-sidad, se ha evidenciado un incremento significativo en las publicaciones que avalan excelentes resultados para el tra-tamiento de los pacientes con obesidad y con diabetes mellitus tipo 2 mediante la cirugía bariátrica y metabólica 2,5,6. En el año 2016 la publicación del Diabetes Sur-gery Summit (DSS2)7 marca diferencia en el manejo de los pacientes con diabetes mellitus tipo 2, es así que las mismas han crecido sustancialmente y la evidencia demuestra que el manejo metabólico ba-riátrico de estos pacientes es superior al manejo médico y cambios de estilo de vida cuando se evalúa el control glucémico y remisión de las comorbilidades. Con la evaluación previa del equipo mul-tidisciplinario, tendremos información científica del más alto nivel que nos per-mita tener un paciente con recuperación óptima aplicando los criterios de En-hanced Recovery after Bariatric Surgery (ERASB)8. En el Ecuador, la obesidad se ha conver-tido en un problema de salud pública, es así que en la población pediátrica ha au-mentado desde el año 1986 pasando del 8,0% al 26,0% para el año 2012 en el grupo de 11 a 19 años. La prevalencia de sobrepeso y obesidad en población adulta en el Ecuador es del 62,8%, según el sexo es 5,5% mayor en las mujeres (65,5%) que en los hombres (60,0%), y el mayor índice de obesidad y sobrepeso se pre-senta entre la cuarta y quinta décadas de vida, con prevalencias superiores a 73,0%9,10.

Currently, obesity is considered a pan-demic, the incidence of which has tripled in the last 30 years, and has generated in-creasing public health problems. Based on the guidelines of the American As-sociation of Endocrinologists (AACE), the Obesity Society, the American So-ciety for Metabolic and Bariatric Surgery (ASMBS), the Association for Obesity Medicine and the American Association of Anesthesiologists, this document is intended to serve as a roadmap to guide the procedure to be followed in patients suffering from this chronic disease who come to San Francisco General Hospital (HGSF)1.Obesity is characterized by the use of se-veral medications due to related comor-bidities: cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease, meta-bolic syndrome and several types of can-cers2. This protocol contains the highest level of evidence available to date, in relation to the surgical and non-surgical management of the patient with a diag-nosis of obesity, including issues such as the identification of candidate patients for bariatric procedures, type of proce-dures that should be offered, preopera-tive, trans-operative management and fo-llow-up post-operative care2-4.Since the publication by the American So-ciety for Metabolic and Bariatric Surgery (ASMBS) in 2013 of the guidelines for the management of patients with obesity, there has been a significant increase in publications that support excellent results for the treatment of patients with obesity and type 2 diabetes mellitus through bariatric and metabolic surgery2,5,6. In 2016 the pu-blication of the Diabetes Surgery Summit (DSS2)7 makes a difference in the mana-gement of patients with type 2 diabetes mellitus, it is so that the same have grown substantially and the evidence shows that bariatric metabolic management of these patients is superior to medical manage-ment and lifestyle changes when glycemic control and remission of comor-bidities are evaluated. With the previous evaluation of the multidisciplinary team, we will have scientific information of the highest level that will allow us to have a patient with optimal recovery applying the criteria of Enhanced Recovery after Bariatric Surgery (ERASB)8.In Ecuador, obesity has become a public health problem; thus, in the pediatric population it has increased since 1986 from 8,0% to 26,0% in 2012 in the 11 to 19 years age group. The prevalence of overweight and obesity in the adult po-pulation in Ecuador is 62,8%, according to sex is 5,5% higher in women (65,5%) than in men (60,0%), and the highest rate of obesity and overweight occurs between the fourth and fifth decades of life, with prevalences higher than 73,0%9,10.

Valoración y aprendizajes atribuidos al taller Mindful Eating en un grupo de mujeres en tratamiento de reducción de peso / EVALUATION AND LEARNINGS IN A GROUP OF WOMEN IN WEIGHT REDUCTION TREATMENT AS MINDFUL EATING

Las intervenciones en mindful eating están siendo cada vez más utilizadas para tratar problemáticas relacionadas con la alimentación. En población con sobrepeso y obesidad esta herramienta busca disminuir los síntomas de atracón, mejorar la regulación emocional y conciencia de los estados internos de hambre y saciedad. Objetivo: conocer la valoración y aprendizajes atribuidos al taller Mindful Eating en un grupo de mujeres en tratamiento de reducción de peso en un centro de salud privado. Método: enfoque metodológico cualitativo, de alcance exploratorio y descriptivo. Para recolectar los datos se utilizaron entrevistas en profundidad semi- estructuradas a 7 mujeres entre 22-54 años, analizadas desde el modelo de la Grounded Theory. Resultados: a partir del taller hubo cambios en el modo de relacionarse con la comida y el sí mismas. Antes del taller las participantes tenían una relación inconsciente con la comida; comer en piloto automático, comer emocional, atracones y modo de relacionarse consigo mismas desde la autocrítica y autocastigo. Posterior al taller, se describen cambios favorables en una relación consciente con la comida, destacándose mayor conexión interna, autocuidado y modo de relacionarse sí mismas autocompasivo. Discusión: las participantes tuvieron una valoración positiva del taller mindful eating, apreciando el rol contendor del grupo, ser una herramienta de utilidad y uso a largo plazo que posibilitaría un cambio hacia una relación más saludable con la comida y si mimas. Sería útil integrar esta herramienta en los programas de control de peso, monitoreando y reforzando continuamente los aprendizajes que los participantes hayan obtenido en el taller. Esta integración podría ayudar a los participantes a continuar utilizando herramienta y, al hacerlo, ayudarlos a integrar hábitos alimenticios más saludables a largo plazo.

Summary Mindful eating interventions are being increasingly used to treat eating behavior problems. In overweight and obese population this tool seeks to reduce symptoms of binge eating, improve emotional regulation, and increase awareness of hunger and satiety.Aim of the study: to investigate how a group of women in weight reduction treatment assessed a mindful eating workshop and what were the main learnings they had from the program. Method: qualitative approach with an exploratory and descriptive scope. Data were collected through semi-structured in-depth interviews. Participants were 7 women between 22-54 years old.  The data analysis was carried out using Grounded Theory model. Results: participants in the workshop reported changes in the way they relate to the food and themselves. Before the workshop, the participants reported not being aware of their relationship to the food, eating on autopilot, eating emotionally, bingeing, and being self-critical and punishing themselves. After the workshop, participants reported changes, experiencing increased awareness of their relationship with food, greater connection to the inner-self, and increased self-care and self-compassion. Discussion: participants had a positive assessment of the  minRPM Nº 11-2019.indd 798 13/12/19 12:50 LA PRENSA MÉDICA ARGENTINA Valoración y aprendizajes atribuidos al taller Mindful Eating en un grupo de mujeres en tratamiento… 799 V.105/Nº11 dful eating  workshop, highlighting the buffering effect of the group, considering mindfulness as a useful and long-term tool that would allow them to have a healthier relationship with food and with one-self. It would be useful to integrate this tool in weight control treatments, monitoring and reinforcing the learnings participants have from the workshop. Having this integration might help participants to continuing using the tool and, by doing that, helping them to integrate healthier eating habits in the long term.

Concentración de adiponectina posterior a reducción de masa corporal en un grupo de mujeres obesas premenopáusicas en Lima, Perú / Adiponectin concentration after a body mass reduction in a group of premenopausal obese women living in Lima, Peru

Objetivo: Investigar el cambio en la concentración de adiponectina circulante en plasma en 23 mujeres obesas premenopáusicas de la ciudad de Lima luego de la reducción de la masa corporal como resultado de un programa de actividad física aeróbica y una dieta baja en calorías.Materiales y métodos: Se llevó a cabo un estudio analítico y cuasi-experimental con el grupo de mujeres obesas. Adicionalmente, 24 mujeres se consideraron como control o de referencia de la concentración de adiponectina y otros marcadores bioquímicos. La cuantificación de adiponectina se realizó mediante la prueba de ELISA. La concentración de glucosa en ayunas en sangre, colesterol, lipoproteína de alta densidad y triglicéridos fueron cuantificados mediante análisis clínicos de rutina.Resultados: Antes del programa el grupo control mostró altos valores de adiponectina (mediana: 8,54 µg/mL; rango: 6,14 µg/mL a 13,49 µg/mL) en comparación con el grupo obesidad (mediana: 7,03 µg/mL, rango: 3;77 µg/mL a 17,23 µg/mL); sin embargo, la diferencia no fue estadísticamente significativa (P = 0.0563). Luego de la finalización del programa se observó que el grupo obesidad presentó una reducción estadísticamente significativa del índice de masa corporal (P = 5.98e-08) y de la circunferencia abdominal (P = 1.55e-08) así como un incremento estadísticamente significativo de los niveles de adiponectina (mediana, 8.79 µg/mL; rango, 5.50 µg/mL a 19.37 µg/mL) (P = 0.0127). Conclusiones: Basándonos en los resultados, concluimos que en mujeres obesas premenopáusicas la concentración de adiponectina se incrementa cuando la masa corporal se reduce como resultado de actividad física aeróbica y una dieta baja en calorías.

Objective: To investigate the changes in the plasma-circulating adiponectin concentration in 23 premenopausal obese women living in Lima after a body mass reduction as a result of an aerobic physical activity program and a low-calorie diet.Materials and methods: An analytical and quasi-experimental study was conducted in a group of obese women. In addition, another 24 women were considered as control or reference group for comparing their adiponectin concentration and other biochemical markers. The quantification of adiponectin was carried out using the ELISA test. Fasting blood glucose concentration, cholesterol, high-density lipoprotein and triglycerides levels were quantified by routine clinical analysis.Results: Before beginning the program, the control group showed high adiponectin levels (median, 8.54 µg/mL; range, 6.14 µg/mL to 13.49 µg/mL) compared to the obesity group (median, 7.03 µg/mL; range, 3.77 µg/mL to 17.23 µg/mL). However, the difference was not statistically significant (P = 0.0563). Once the program was finished, the obesity group showed a statistically significant reduction in the body mass index (P = 5.98e-08) and abdominal circumference (P = 1.55e-08), and a statistically significant increase in the adiponectin levels (median, 8.79 µg/mL; range, 5.50 µg/mL to 19.37 µg/mL) (P = 0.0127). Conclusions: Based on the results, we conclude that the adiponectin concentration in premenopausal obese women increases when the body mass is reduced as a result of aerobic physical activity and a low-calorie diet.

A Structured Literature Review on the Role of Mindfulness Intervention in Weight Control

Mindfulness training is growing in popularity as an adjunctive intervention in disordered eating and weight loss. Lifestyle modification, pharmacologic treatment, and surgical intervention have been widely used for weight reduction in obese persons, but these modifications are sometimes insufficient. In particular, stress-induced eating and binge-eating disorder have been frequently associated with increased risk of regaining weight. Initial research suggests that mindfulness training may be an effective intervention for binge eating. In this article, we reviewed 19 studies that investigated mindfulness training as an intervention for weight change and/or emotional eating. Results suggest that mindfulness training effectively decreases emotional eating in persons with good adherence to the training; evidence for its effect on weight reduction, however, is mixed. Further large-scale studies are warranted to explore the effectiveness of mindfulness training on long-term weight loss and emotional eating in persons with obesity.

Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs

Objective: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. Method: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. Results: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. Conclusion: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

Em busca do peso perdido: a institucionalização de demandas culturais nos Vigilantes do Peso / In search of lost weight: the institutionalization of cultural demands on Weight Watchers / A la búsqueda del peso perdido: la institucionalización de demandasculturales en los Vigilantes del Peso

O espírito do tempo pode ser apreendido pela sua produção cultural, que se constitui como expressão da identidade cultural do grupo que a produz. Na nossa sociedade, a demanda pela posse e exibição de certo ideal corpóreo manifesta-se sob a forma de instituições que funcionam como legitimadoras de um saber pragmático orientado para aquisição do corpo idealizado, como os Vigilantes do Peso. Esta instituição promove uma forma contemporânea de sociabilidade a partir de grupos de auxílio mútuo nos quais as pessoas buscam conformar o próprio corpo ao padrão visado. A partir do estudo de peças midiáticas dos Vigilantes do Peso, três mecanismos estratégicos discursivos são observados: i) o diferencial ostentado em relação à concorrência se baseia na razão e no saber científico; ii) as estratégias retóricas se baseiam na valorização da individualidade; e iii) o paradoxo que essas estratégias representam, uma vez que o valor indivíduo está subordinado à opinião dos outros.(AU

The zeitgeist of a society can be caught in its cultural production, which is an expression of the culturalidentity of the groups that produces it. In our society, the demand for the acquisition and for the exhibitionof an ideal body is manifested by institutions such as the Weight Watchers that legitimate a pragmatic knowledge in quest of the ideal body. This institution promotes sociability by means of mutual aid groupswhere people seek to conform their own body to the idealized pattern. Through the analysis of the media communication of the Weight Watchers, three strategic discursive mechanisms were observed: i) their alleged difference regarding their competitors is based on reason and scientific knowledge; ii) the rhetorical strategies are based on the importance of individuality; and iii) the paradox that these strategies represent,as the value of individuality is being subordinated to the opinion of others.

El espíritu del tiempo de una sociedad puede ser aprehendido por su producción cultural, que es unaexpresión de la identidad cultural del grupo que la produce. En nuestra sociedad, la demanda por la obtención y exibición de un cuerpo ideal se manifesta en instituciones que actúan como legitimadoras de la búsqueda del cuerpo ideal, como los Vigilantes del Peso. Esta institución promueve sociabilidad mediante grupos de ayuda mutua donde la gente busca conformar sus cuerpos al ideal propuesto. A partir del estudio de piezas de comunicación de los Vigilantes del Peso se observan tres mecanismos estratégicos discursivos:i) la diferencia alegada hacia sus competidores se basa en la razón y en el conocimiento científico; ii) las estrategias retóricas exaltan el valor de la individualidad; y iii) la paradoja que estas estrategias presentan, en vista del valor del individuo estar subjecto a la evaluación de los otros.

Intervención integral en personas con obesidad: carencia de herramientas psicológicas / Comprehensive intervention in obese people: lack of psychological tools

La presente misiva busca contribuir a la discusión relacionada con la intervención médica en personas con obesidad, problema de salud pública que afecta a un gran número de personas en el mundo; circunscribiéndose a Latinoamérica, la realidad resulta alarmante, pues como lo refieren distintos informes recientes de la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO), América Latina y el Caribe encabezan la lista de regiones geográficas que exhiben en los últimos años un aumento significativo de personas con obesidad.1 El Perú no es ajeno a la situación expuesta, el país experimenta un crecimiento gradual que está generando preocupación en las autoridades, ante lo cual, en los últimos años se emprendieron campañas que buscan promover hábitos saludables en la población, con especial atención en niños y adolescentes, grupos en relación con los cuales se registran evidencias que los catalogan como poblaciones de mayor vulnerabilidad a situaciones de riesgo, como la exposición a publicidad de alimentos no saludables y la ausencia de programas adecuados de actividad física en las instituciones educativas.2 Asimismo, diferentes organizaciones señalan que la obesidad está acarreando costos económicos y humanos,3 por lo que a las campañas preventivas, se suman actividades que orientan a los profesionales inmersos en el ámbito de la salud a reflexionar sobre el quehacer en la intervención en personas con obesidad. Esta intervención permitirá visualizar que la obesidad es una enfermedad que trae consigo consecuencias físicas y psicológicas, por lo que resulta necesaria una atención integral, sin embargo, en el contexto peruano y latinoamericano, la intervención a pacientes obesos se orienta al empleo de recursos de carácter médico y se descuida en muchos casos el uso de herramientas psicológicas.4 En las últimas décadas diversos estudios realizados en el escenario internacional publican que las personas con obesidad experimentan niveles elevados de ansiedad y depresión, lo cual conllevó al desarrollo de modelos psicológicos que explican la interacción clínica y sociocultural de variables como la personalidad, el comportamiento, las emociones y cogniciones, que permiten comprender los procesos psicológicos subyacentes al desarrollo de la imagen corporal, la conducta alimentaria y la actividad física en personas con obesidad.5 En función a lo mencionado, la intervención médica en obesidad, por la naturaleza del problema, amerita acompañarse de una intervención psicológica, sin embargo, en la práctica se aprecia lo contrario. Por lo expuesto, se presentan dos necesidades cruciales para trabajar un abordaje integral en personas que padecen obesidad, por una parte, la inclusión de variables psicológicas en el estudio de la obesidad que permita reconocer diferentes aspectos y generar conocimientos acerca del tema, y por otra, a partir de los conocimientos generados elaborar tecnologías (herramientas) para intervenciones eficaces. Cabe señalar que la tarea de trabajar con variables psicológicas no es menester exclusivo de los psicólogos, en problemáticas de salud pública constituye una necesidad impostergable romper fronteras y emprender estudios que involucren a equipos multidisciplinarios(AU)

Effects of health management programs on weight among overweight or obese adults / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the effect of weight-loss for overweight or obese population under the health management programs, and to provide evidence for the development of safe and effective weight-loss programs.</p><p><b>METHODS</b>738 participants who resided in Beijing longer than one year, under 22 to 55 years of age, with BMI≥24 kg/m(2) and without organic diseases were voluntarily recruited, from September 1(st) to October 15(th) 2013. All the participants were randomly divided into general management group or under health management group, in which all the subjects received intervention measures for 6 months. Anthropometry and body composition were measured at baseline and 6 months for all the subjects. Weight-loss effect from the health management programs was evaluated through analyzing the changes on weight and body fat.</p><p><b>RESULTS</b>618 participants completed the follow-up process, including 321 in the general management group and 297 in the health management group. 6 months after the intervention process, values of weight and body fat rate in the two groups appeared both significantly lower than that at the baseline levels. Difference before and after the intervention program was statistically significant (P<0.001). However, the differences of those with reduction value as 2.19 kg or 2.19% among health management group were higher than that in the general management group, which were 0.97 kg and 1.28% respectively, with difference statistically significant (P<0.001). The effective rate of 24.2% loss-weight and the 52.5% losing rate on body fat among the health management group were both higher than 11.8% and 34.3%, seen in the general management group, respectively, with difference statistically significant (P<0.001).</p><p><b>CONCLUSION</b>The healthy management programs could effectively control the weight and body fate rate among the overweight or obese adults.</p>

Characterizing the Profile of Obese Patients: Example from the Newly Opened Obesity Clinic at a Single University Hospital

PURPOSE: An obesity clinic was newly opened at a single university hospital in South Korea. We aimed to characterize the profile of patients and current status of the clinic. MATERIALS AND METHODS: 60 patients who have visited the obesity clinic from October 2015 to April 2016 were included in this study. Baseline examination included anthropometric measurement, bioelectrical impedance analysis, blood sampling, and abdominal computed tomography (CT) analysis to estimate abdominal fat distribution. Weight loss program of the clinic constituted of 8 sessions of physician encounter and nutrition counselling. Data on the profile of patients and their completion status were collected and analyzed. RESULTS: Sixty obese adults (21 males and 39 females) were included in the study. The mean (±standard deviation [SD]) body mass index was 31.1±5.7, and abdominal circumference was 100.2±18.3. The mean±SD percentage of body fat measured by bioelectrical impedance analysis was analyzed 35.7±6.2% in males, and 40.6±6.2% in females. The average intra-abdominal fat area was 243.7 cc in males, and 142.5 cc in females. Among 60 subjects, 37 patients (61.7%) are currently on their sessions; 11 patients (18.3%) completed 8 sessions of the program; 8 patients (13.3%) dropped out; 4 patients (6.7%) did not register the program session with initial evaluation only. The mean weight loss (kg) of 11 completers was 5.1 kg. CONCLUSION: Using the strengths of a university hospital as multidisciplinary team care, effective treatment strategies for overweight and obesity are the future directions of our clinic.

Chronic intermittent hypoxia increases encoding pigment epithelium-derived factor gene expression, although not that of the protein itself, in the temporal cortex of rats, / Hipóxia intermitente crônica aumenta a expressão gênica, mas não proteica, de pigment epithelium-derived factor no córtex temporal de ratos

Objective: Obstructive sleep apnea syndrome is mainly characterized by intermittent hypoxia (IH) during sleep, being associated with several complications. Exposure to IH is the most widely used animal model of sleep apnea, short-term IH exposure resulting in cognitive and neuronal impairment. Pigment epithelium-derived factor (PEDF) is a hypoxia-sensitive factor acting as a neurotrophic, neuroprotective, and antiangiogenic agent. Our study analyzed performance on learning and cognitive tasks, as well as PEDF gene expression and PEDF protein expression in specific brain structures, in rats exposed to long-term IH. Methods: Male Wistar rats were exposed to IH (oxygen concentrations of 21-5%) for 6 weeks-the chronic IH (CIH) group-or normoxia for 6 weeks-the control group. After CIH exposure, a group of rats were allowed to recover under normoxic conditions for 2 weeks (the CIH+N group). All rats underwent the Morris water maze test for learning and memory, PEDF gene expression and PEDF protein expression in the hippocampus, frontal cortex, and temporal cortex being subsequently assessed. Results: The CIH and CIH+N groups showed increased PEDF gene expression in the temporal cortex, PEDF protein expression remaining unaltered. PEDF gene expression and PEDF protein expression remained unaltered in the frontal cortex and hippocampus. Long-term exposure to IH did not affect cognitive function. Conclusions: Long-term exposure to IH selectively increases PEDF gene expression at the transcriptional level, although only in the temporal cortex. This increase is probably a protective mechanism against IH-induced injury. .

Objetivo: A síndrome da apneia obstrutiva do sono caracteriza-se principalmente por episódios de hipóxia intermitente (HI) durante o sono e associa-se a diversas complicações. A exposição à HI é o mais usado modelo animal de apneia do sono, e protocolos de curta duração causam diversos prejuízos cognitivos e neuronais. Pigment epithelium-derived factor (PEDF, fator derivado do epitélio pigmentado) é um fator neurotrófico, neuroprotetor e antiangiogênico sensível à hipóxia celular. Nosso estudo analisou o desempenho em tarefas cognitivas e de aprendizagem, bem como a expressão do gene PEDF e da proteína PEDF em estruturas cerebrais específicas em ratos expostos a HI de longa duração. Métodos: Ratos Wistar foram expostos a HI (21-5% de oxigênio) durante 6 semanas - o grupo HI crônica (HIC) - ou a normóxia durante 6 semanas - o grupo controle. Após a exposição à HIC, um grupo de ratos foi exposto a normóxia durante 2 semanas (o grupo HIC+N). Todos os animais foram submetidos ao labirinto aquático de Morris para avaliação de memória e aprendizado; avaliou-se também a expressão do gene PEDF e da proteína PEDF no hipocampo e nos córtices frontal e temporal. Resultados: Os grupos HIC e HIC+N apresentaram um aumento de expressão do gene PEDF no córtex temporal, porém sem aumento dos níveis proteicos. A expressão do gene PEDF e da proteína PEDF manteve-se inalterada nas demais estruturas. A exposição de longa duração à HI não afetou a função cognitiva. Conclusões: A exposição de longa duração à HI aumenta seletivamente a expressão do gene PEDF ao nível transcricional, embora apenas no córtex temporal. Esse aumento é provavelmente um mecanismo de proteção contra a HI. .

Interaction Effect between Weight Perception and Comorbidities on Weight Control Behavior in Overweight and Obese Adults: Is There a Sex Difference?

We investigated the interaction effect between body weight perception and chronic disease comorbidities on body weight control behavior in overweight/obese Korean adults. We analyzed data from 9,138 overweight/obese adults > or =20 yr of age from a nationally representative cross-sectional survey. Multiple logistic regression using an interaction model was performed to estimate the effect of chronic disease comorbidities on weight control behavior regarding weight perception. Adjusted odds ratios for weight control behavior tended to increase significantly with an increasing number of comorbidities in men regardless of weight perception (P<0.05 for trend), suggesting no interaction. Unlike women who perceived their weight accurately, women who under-perceived their weight did not show significant improvements in weight control behavior even with an increasing number of comorbidities. Thus, a significant interaction between weight perception and comorbidities was found only in women (P=0.031 for interaction). The effect of the relationship between accurate weight perception and chronic disease comorbidities on weight control behavior varied by sex. Improving awareness of body image is particularly necessary for overweight and obese women to prevent complications.

Demographic profile, clinical characteristics, motivations and weight loss outcomes of patients in a nonsurgical weight management programme

<p><b>INTRODUCTION</b>Weight management programmes (WMPs) can help overweight individuals lose weight, and thus prevent complications associated with obesity. Herein, we describe the demographic profile, clinical characteristics, motivations and expectations, and outcomes of patients enrolled in a nonsurgical WMP.</p><p><b>METHODS</b>This was a retrospective study of consecutive patients with a body mass index (BMI) of > 23 kg/m2 enrolled in the four-month WMP at the Health For Life Clinic, Alexandra Hospital, Singapore, between 1 and 31 August 2009. Demographic data, medical history and source of referral were recorded. Details on personal motivations and weight loss goals were obtained from the completed self-administered questionnaires of the WMP participants. Weight, waist circumference, fat percentage and BMI were measured at the start and end of the WMP. A weight loss of ≥ 5% was deemed as a successful outcome.</p><p><b>RESULTS</b>A total of 58 patients (mean age 37.2 years) were included in our study. Of these 58 patients, 58.6% were of Chinese ethnicity and 55.2% were male. Many patients (32.8%) attributed their weight gain to work- or study-related stress, and a minority to poor eating habits (12.1%) or a lack of exercise (10.3%). Patients' motivations included a desire for better health (53.4%) and better fitness (15.5%). However, only 53.4% patients scored their motivation as high (i.e. a score of > 7). The mean expected weight loss was 9.9 kg at 4 months, and 14.1 kg at 12 months. Among the 40 patients (69.0%) who completed the programme, the mean percentage weight loss was 1.8 ± 4.3%. A weight loss of ≥ 5% was achieved by 8 (13.8%) patients.</p><p><b>CONCLUSION</b>Although the patients in our study cohort were young and educated, only a portion of them appeared to be highly motivated to lose weight, despite joining the WMP. There is a need for patients to be guided on how to set realistic weight loss goals.</p>

Effect of a Diet Program for Adult Women on Body Weight Loss and Health Related Indices / 대한지역사회영양학회지

This study was carried out to analyze the effect of a diet program for adult women on weight loss, BMI, eating habits, sleeping habits, health related indices. The subjects was 415 participants of the 10 weeks (20 time participation program). The data was collected by basic somatometry and HRV (Heart Rate Variability) / APG (Accelerated Plethysmograph) Analyzer. The average age, height, weight and BMI were 28.6 years, 162.1 cm, 62.8 kg and 23.9 kg/m2, respectively. Their body types by BMI were under weight (1.2%), normal (45.8%), overweight (24.8%), mild obesity (22.7%) and obesity (5.5%). There were significant reductions of average weight (4.6 kg) and average BMI (1.75 kg/m2) on the 10th week. There were positive changes in vascular age (50.4%), stress index (44.6%), fatigue index (43.9%), health index (54.5%) of the subjects during the program. There was a meaningful difference of the average variation for the vascular age, stress index, fatigue index, and health index between two groups; one improving the eating habit and the other did not (p < 0.05), and also there was a meaningful difference of the average variation for the fatigue index in both groups improving the sleeping habit (p < 0.05), but was not a meaningful difference of the average variation for the vascular age, stress index, and health index between two groups. There was a meaningful difference of the average variation for the vascular age, stress index, fatigue index, and health index between two groups improving both eating and sleeping habit (p < 0.05). In conclusion, the weight loss program was effective on the weight loss and BMI reduction and health related indices.

Hypertension management and lifestyle changes following screening for hypertension in an Asian low socioeconomic status community: a prospective study

<p><b>INTRODUCTION</b>This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined.</p><p><b>MATERIALS AND METHODS</b>The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up.</p><p><b>RESULTS</b>The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99).</p><p><b>CONCLUSION</b>An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.</p>

Body Image Distortion among Inpatients with Schizophrenia

OBJECTIVES: Body image distortion is found in eating disorder and obesity and there are some evidence that schizophrenia is associated with body image distortion. This study sought to find whether schizophrenic patients report more body image distortion than healthy individuals and whether it is related with symptomatology. METHODS: A total of 88 inpatients with schizophrenia and 88 healthy controls were recruited. Weight, height, and body image accuracy were assessed in all participants, and assessment of mood, psychotic symptom severity and self-esteem, and personal and social performance scale were conducted. RESULTS: The patients with schizophrenia had higher Body Mass Index (p < 0. 001) and underestimated their body size more than controls (26.14% vs. 5.13%, p < 0.001). Multiple regression analysis showed that lower depressive symptoms and higher scores of general psychopathology predicted underestimation of body size. CONCLUSION: Weight gain and metabolic syndrome are common adverse events of pharmacological treatment of schizophrenia. Thus, underestimation of body size among patients with schizophrenia may interfere with effort to lose weight or seek weight reduction programs. Clinicians need to consider possible unterestimation of underestimation of body size in patients whose general symptomatology is severe.

The Effect of Weight Reduction on the Obesity-Related Quality of Life, Physical and Emotional Well-Being in Obese Schizophrenic Inpatients / 대한정신약물학회지

OBJECTIVE: The purpose of this study was to assess the effect of the weight reduction program designed for schizophrenic patients. It's effects were assessed especially in the aspects of the obesity-related quality of life, emotional and physical well-being of the patients. METHODS: Fifty-one obese schizophrenic inpatients were enrolled in a 12-week, randomized weight reduction program. Thirty-two patients were randomly assigned to an intervention group in which they received the weight management program. Nineteen patients were allocated to the control group in which they received the usual clinical inpatient treatments. Body weight, Body Mass Index (BMI) and Quality of Life Scales such as Short Form of Medical Outcome Study (SF-36), Korean version of Obesity-related Quality of Life Scale (KOQOL) and Korean version of Body Weight, Image and Self-Esteem Evaluation Questionnaire (B-WISE-K) were evaluated during 12-week period. All assessments were done at baseline, 4, 8 and 12 week. Repeated measures of analysis of variance and post-hoc comparisons were done to compare the group differences from baseline at each visit. RESULTS: Sixteen of 32 (50%) patients in intervention group and 12 of 19 (69.4%) patients in control group completed this study. We found significant group by time interaction effects in weight, BMI and waist circumferences (p<0.05, respectively). The weight changes from baseline to 8 week and 12 week were significant in post-hoc comparisons between intervention and control groups (p<0.05 and p<0.01, respectively). The changes of BMI and waist circumference from baseline to 12-week were also significant in post-hoc comparisons (p<0.05). After completion of the weight management program, there were significant differences on the subjective estimates such as physical component summary of SF-36, and total scores, psychosocial heath, physical health and diet of the KOQOL, and total scores of B-WISE-K between intervention and control group. These significant differences were found at 12-week of treatment in post-hoc comparisons (p<0.05, respectively). CONCLUSION: The weight reduction program was effective for weight loss in schizophrenic inpatients. In addition, it might improve the subjective estimates such as obesity-related quality of life and weight-related body image in schizophrenic inpatients.

The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study / Efetividade de uma intervenção não farmacológica para manejo do ganho de peso em pacientes com transtornos mentais graves: resultados de um estudo multicêntrico

OBJECTIVE: To evaluate the effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders. METHOD: An open, multicentre interventional study was conducted in 93 mental health services. Patients concerned with weight gain were included in this study and received a 12-week 1-hour group intervention focused on nutrition counseling, lifestyle, physical activity and self-esteem. Weight, waist circumference and blood pressure were measured before and after the intervention. RESULTS: 1,071 patients were enrolled in the study, and 73.9 percent completed the 12-week intervention. Significant weight loss (Mean difference: 0.41, CI 95 percent: 0.18 to 0.64, p = 0.001) and a significant BMI reduction (Mean difference: 0.13, CI 95 percent: 0.04 to 0.22, p = 0.006) were observed. During the intervention 37 (4.4 percent) patients lost > 7 percent of their initial weight, 780 (92.5 percent) maintained their weight, and 26 (3.1 percent) of the patients had a meaningful weight gain (> 7 percent). There was a significant increase in the proportion of patients undertaking physical activity after the intervention (70.8 percent, p < 0.001). CONCLUSION: In this 3-month open study we found a small weight and waist reduction, and increased physical activity practice, suggesting a trend towards anthropometric profile improvement. However, further randomized-controlled trials are necessary to evaluate the efficacy and clinical relevance of this psychosocial intervention for weight gain.

OBJETIVO: Avaliar a efetividade de uma intervenção não farmacológica no manejo do ganho de peso para pacientes com transtornos mentais graves. MÉTODO: Foi realizado um estudo aberto multicêntrico longitudinal em 93 serviços de saúde. Pacientes preocupados com o peso foram incluídos e participaram de uma intervenção em grupo de uma hora de duração durante 12 semanas com foco em educação alimentar, atividade física e autoestima. Peso, circunferência da cintura e pressão arterial foram avaliados antes e após a intervenção. RESULTADOS: 1071 pacientes foram incluídos no estudo, 73,9 por cento completaram a intervenção. Foram observados diminuição de peso e índice de massa corporal significativos (peso: diferença da média: 0,41, IC 95 por cento: 0,18-0,64, p = 0,001; índice de massa corporal: diferença da média: 0,13, IC 95 por cento: 0,04-0,22, p = 0,006). Após a intervenção, 37 (4,4 por cento) pacientes perderam mais que 7 por cento do peso inicial, 780 (92,5 por cento) mantiveram o peso e 26 (3,1 por cento) dos pacientes apresentaram ganho de peso acima de 7 por cento. Houve aumento da proporção de pacientes que praticavam atividade física (70,8 por cento, p < 0,001). CONCLUSÃO: Encontramos uma pequena redução de peso e cinturae aumento de atividade física, sugerindo uma tendência à melhora no perfil antropométrico. Ensaios clínicos controlados e randomizados são necessários para avaliar a eficácia e a relevância clínica dessa intervenção.

The Effects of Moderate Treadmill Running on Free Fatty Acids, Glucose, Growth Hormone, Insulin and Appetite

BACKGROUND: The level of physical adaptation through active lifestyle can result in changes in appetite; and caused by physical activity and exercise, physical adaptation may change carbohydrate and fat metabolism during exercise. This study investigated the differences in carbohydrate and fat metabolism after moderate treadmill running and the difference in appetite response before and after exercise in active, regularly exercising individuals and those inactive. METHODS: We analyzed the effects of moderate physical activity (70% of oxygen uptake reserve, 30 minutes on the treadmill) on free fatty acids, glucose, growth hormone, insulin and an appetite visual analogue scale (VAS). Our subjects included 28 healthy males who were divided into two groups, the activity group (n=14) and the inactivity group (n=14) according to the International Physical Activity Questionnaire (IPAQ). The serum samples and VAS were collected at pre, post and 30 min post-exercise. RESULTS: The results of the serum analysis showed no significant effects on free fatty acids, glucose, growth hormone and insulin between the groups, but showed significant changes in free fatty acids and growth hormone between points of measurement. Significant increases in VAS were seen with moderate exercise in both groups, with the inactivity group expressing greater hunger than the activity group. CONCLUSIONS: This study found that inactive persons were hungrier than active persons after moderate exercise. This information might be useful to staff and participants of weight loss programs.