Alternativas fitoterápicas no controle da obesidade / Phytotherapy alternatives in obesity control / Alternativas herbales en el control de la obesidad

Nos últimos anos, a obesidade vem aumentando consideravelmente entre adultos e crianças e, segundo a OMS, estima-se que em 2025 o número de obesos ultrapasse a 2,3 milhões em todo o mundo. O indivíduo obeso apresenta maiores riscos de desenvolver doenças crônicas não transmissíveis, como diabetes, doenças cardiovasculares, dislipidemias e ainda alguns tipos de cânceres. O tratamento para a obesidade é variado e inclui mudanças no estilo de vida como: hábitos alimentares e prática de atividade física, tratamento medicamentoso, cirurgia bariátrica e fitoterápicos com o potencial de auxiliar no tratamento. O objetivo deste trabalho foi realizar uma revisão bibliográfica a fim de avaliar os benefícios da utilização de medicamentos fitoterápicos como auxiliar no tratamento da obesidade, seus principais ativos, mecanismos de ação e sua utilização popular. Dentre as plantas pesquisadas e que demonstraram potencial para atuar no tratamento da obesidade encontram-se Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale e Senna alexandrina. Os principais mecanismos de ação envolvidos no potencial anti-obesidade das plantas medicinais são a capacidade de controle do apetite e ingestão de energia, estímulo da termogênese, inibição da lipase pancreática e redução da absorção de gordura, diminuição da lipogênese e aumento da lipólise. Desta forma, conclui-se que as plantas selecionadas neste estudo apresentaram efeitos positivos nos parâmetros bioquímicos e físicos, podendo ser incluídas nos protocolos como coadjuvantes nos tratamentos de emagrecimento.

In recent years, obesity has increased considerably among adults and children and according to the WHO, it is estimated that in 2025 the number of obese people will exceed 2.3 million worldwide. The obese individual is at greater risk of developing non-communicable chronic diseases, such as diabetes, cardiovascular disease, dyslipidemia and even some types of cancer. The treatment for obesity is varied, including changes in lifestyle such as eating habits and physical activity, drug treatment, bariatric surgery and phytotherapy with the potential to aid in the treatment. The objective of this work was to carry out a literature review, evaluating the benefits of using herbal medicines as an aid in the treatment of obesity, their main assets, mechanisms of action and their popular use. Among the plants researched and that have shown potential to act in the treatment of obesity are Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber officiale and Senna alexandrina. The main mechanisms of action involved in the antiobesity potential of medicinal plants are the ability to control appetite and energy intake, thermogenesis stimulation, pancreatic lipase inhibition and reduction of fat absorption, lipogenesis decrease and lipolysis increase. Thus, it is concluded that the plants selected in this study showed positive effects on biochemical and physical parameters, and can be included in the protocols as adjuvants in weight loss treatments.

En los últimos años, la obesidad ha aumentado considerablemente entre adultos y niños y, según la OMS, se estima que en 2025 el número de obesos superará los 2,3 millones en todo el mundo. Los individuos obesos tienen un mayor riesgo de desarrollar enfermedades crónicas no transmisibles, como la diabetes, las enfermedades cardiovasculares, las dislipidemias e incluso algunos tipos de cáncer. El tratamiento de la obesidad es variado e incluye cambios en el estilo de vida como: hábitos alimenticios y práctica de actividad física, tratamiento farmacológico, cirugía bariátrica y medicamentos a base de hierbas con potencial para ayudar en el tratamiento. El objetivo de este trabajo fue realizar una revisión bibliográfica para evaluar los beneficios del uso de las hierbas medicinales como ayuda en el tratamiento de la obesidad, sus principales activos, mecanismos de acción y su uso popular. Entre las plantas investigadas y que mostraron potencial para actuar en el tratamiento de la obesidad están Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale y Senna alexandrina. Los principales mecanismos de acción implicados en el potencial antiobesidad de las plantas medicinales son la capacidad de controlar el apetito y la ingesta de energía, estimular la termogénesis, inhibir la lipasa pancreática y reducir la absorción de grasas, disminuir la lipogénesis y aumentar la lipólisis. Por lo tanto, se concluye que las plantas seleccionadas en este estudio mostraron efectos positivos sobre los parámetros bioquímicos y físicos, y pueden ser incluidas en los protocolos como coadyuvantes en los tratamientos de pérdida de peso.

Lisdexamfetamine to improve excessive daytime sleepiness and weight management in narcolepsy: a case series

Objective: To report the successful use of lisdexamfetamine in the management of narcolepsy. Methods: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. Results: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. Conclusion: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.

Non-caloric sweeteners and body weight

Both total caloric intake and consumption of free sugars is higher than recommended. This situation contributes, among many other factors, to the increase of overweight and obesity in the population. To maintain the sweet taste of foods and beverages while reducing the caloric content and the amount of free sugars in said products, many people choose to replace sugary products in their diet for options containing non-caloric sweeteners. This change in their dietary choice is accompanied by an increasing number of consultations with health professionals about the effects that non-caloric sweeteners could have on their body weight. Results reported in different scientific publications seem contradictory in relation to this topic: some of them, showing a positive association between the consumption of non-caloric sweeteners and energy intake and body weight, while others reporting that the consumption of these additives -in replacement of sugar- may lead to a reduction in caloric intake and body weight. The main objective of this article is to review the available evidence on the consumption of non-caloric sweeteners in relation to body weight, thus providing another tool for health professionals to make nutritional recommendations based on the best available evidence.

Tanto la ingesta calórica total como el consumo de azúcares libres son mayores a los recomendados. Esta situación contribuye, entre muchos otros factores, al aumento del sobrepeso y la obesidad en la población. Para mantener el sabor dulce de los alimentos y bebidas, y a la vez reducir el contenido calórico y la cantidad de azúcares en los mismos, cada vez más personas optan por reemplazar los productos azucarados en su dieta por edulcorantes no calóricos. Este cambio dietario se acompaña de un creciente número de consultas con profesionales de la salud, sobre los efectos que los edulcorantes no calóricos podrían tener sobre el peso corporal. Resultados comunicados en diversas publicaciones científicas parecen contradictorios con relación a este tema, algunas informan una asociación positiva entre el consumo de edulcorantes no calóricos, la ingesta energética y el peso corporal, y otras muestran que el consumo de estos aditivos -en reemplazo del azúcar- lleva a una reducción de la ingesta calórica y a un descenso de peso. El principal objetivo de este artículo es repasar la evidencia disponible sobre el consumo de edulcorantes no calóricos con relación al peso corporal, brindando así una herramienta más para que los profesionales de la salud puedan hacer recomendaciones nutricionales basadas en la mejor evidencia disponible.

Anthropometric changes caused by hepatitis C treatment with interferon and ribavirin: which patients and which measures are affected?

BACKGROUND: Chronic hepatitis C causes chronic hepatic inflammation, which can lead to cirrhosis, terminal liver failure, and hepatocellular carcinoma. The treatment aims to achieve viral clearance, but the usage of pegylated interferon and ribavirin is linked to side effects such as severe weight loss, which can lead to complications and treatment discontinuation. The aim of this study was to investigate which anthropometric measures were more affected in patients with chronic hepatitis C during 24 weeks of treatment with pegy lated interferon and ribavirin. Then, the influence of age, sex, hepatic fibrosis stage, and ribavirin doses on each measure was also evaluated. METHODS: Seventy-six patients were included and their weight, triceps skin fold thickness, arm circumference, middle-arm muscle circumference, and corrected arm muscle area were measured before and after 24 weeks of treatment. Epidemiological data and liver biopsy findings were obtained from patients' records. The sample was divided into two groups: one with advanced hepatic fibrosis and another group with mild to moderate fibrosis. Comparisons into each group were made using Wilcoxon or paired tests. After that, a linear regression model was applied to estimate the anthropometric changes during the treatment according to age, sex, hepatic fibrosis stage, and ribavirin doses. RESULTS: The subjects suffered reductions of important anthropometric measures, mainly related to fat mass (p<0.001).Some decrease of fat-free mass was also observed in subjects with advanced fibrosis. The statistic model showed that age and sex were more associated with the anthropometric changes observed. CONCLUSIONS: In conclusion, the antiviral treatment caused loss of relevant anthropometric measures, and the model proposed was able to estimate some of them

Oral insulin improves metabolic parameters in high fat diet fed rats

ABSTRACT Introduction/Aim: The gut has shown to have a pivotal role on the pathophysiology of metabolic disease. Food stimulation of distal intestinal segments promotes enterohormones secretion influencing insulin metabolism. In diabetic rats, oral insulin has potential to change intestinal epithelium behavior. This macromolecule promotes positive effects on laboratorial metabolic parameters and decreases diabetic intestinal hypertrophy. This study aims to test if oral insulin can influence metabolic parameters and intestinal weight in obese non-diabetic rats. Methods: Twelve weeks old Wistar rats were divided in 3 groups: control (CTRL) standard chow group; high fat diet low carbohydrates group (HFD) and HFD plus daily oral 20U insulin gavage (HFD+INS). Weight and food consumption were weekly obtained. After eight weeks, fasting blood samples were collected for laboratorial analysis. After euthanasia gut samples were isolated. Results: Rat oral insulin treatment decreased body weight gain (p<0,001), fasting glucose and triglycerides serum levels (p<0,05) an increased intestinal weight of distal ileum (P<0,05). Animal submitted to high fat diet presented higher levels of HOMA-IR although significant difference to CT was not achieved. HOMA-beta were significantly higher (p<0.05) in HFD+INS. Visceral fat was 10% lower in HFD+INS but the difference was not significant. Conclusions: In non-diabetic obese rats, oral insulin improves metabolic malfunction associated to rescue of beta-cell activity.

Systematic review and meta-analysis of the efficacy and safety of amfepramone and mazindol as a monotherapy for the treatment of obese or overweight patients

The aim of this study was to evaluate efficacy and safety of amfepramone, fenproporex and mazindol as a monotherapy for the treatment of obese or overweight patients. A systematic review of primary studies was conducted, followed by a direct meta-analysis (random effect) and mixed treatment comparison. Medline and other databases were searched. Heterogeneity was explored through I2 associated with a p-value. Of 739 identified publications, 25 were included in the meta-analysis. The global evaluation of Cochrane resulted in 19 studies with a high level of bias and six with unclear risk. Due to the lack of information in primary studies, direct meta-analyses were conducted only for amfepramone and mazindol. Compared to placebo, amfepramone resulted in higher weight loss in the short-term (<180 days; mean difference (MD) -1.281 kg; p<0.05; I2: 0.0%; p=0.379) and long-term (≥180 days; MD -6.518 kg; p<0.05; I2: 0.0%; p=0.719). Only studies with long-term follow up reported efficacy in terms of abdominal circumference and 5-10% weight reduction. These results corroborated the finding that the efficacy of amfepramone is greater than that of placebo. Treatment with mazindol showed greater short-term weight loss than that with placebo (MD -1.721 kg; p<0.05; I2: 0.9%; p=0.388). However, metabolic outcomes were poorly described, preventing a meta-analysis. A mixed treatment comparison corroborated the direct meta-analysis. Considering the high level of risk of bias and the absence of important published outcomes for anti-obesity therapy assessments, this study found that the evaluated drugs showed poor evidence of efficacy in the treatment of overweight and obese patients. Robust safety data were not identified to suggest changes in their regulatory status.

Gender differences in biochemical markers and oxidative stress of rats after 28 days oral exposure to a mixture used for weight loss containing p-synephrine, ephedrine, salicin, and caffeine

ABSTRACT The association of p-synephrine, ephedrine, salicin, and caffeine in dietary supplements and weight loss products is very common worldwide, even though ephedrine has been prohibited in many countries. The aim of this study was to evaluate a 28-day oral exposure toxicity profile of p-synephrine, ephedrine, salicin, and caffeine mixture (10:4:6:80 w/w respectively) in male and female Wistar rats. Body weight and signs of toxicity, morbidity, and mortality were observed daily. After 28 days, animals were euthanized and blood collected for hematological, biochemical, and oxidative stress evaluation. No clinical signs of toxicity, significant weight loss or deaths occurred, nor were there any significant alterations in hematological parameters. Biochemical and oxidative stress biomarkers showed lipid peroxidation, and hepatic and renal damage (p < 0.05; ANOVA/Bonferroni) in male rats (100 and 150 mg/kg) and a reduction (p < 0.05; ANOVA/Bonferroni) in glutathione (GSH) levels in all male groups. Female groups displayed no indications of oxidative stress or biochemical alterations. The different toxicity profile displayed by male and female rats suggests a hormonal influence on mixture effects. Results demonstrated that the tested mixture can alter oxidative status and promote renal and hepatic damages.

RESUMO A associação de p-sinefrina, efedrina, salicina, e cafeína em suplementos alimentares e produtos para perda de peso é muito utilizada em todo o mundo, embora a efedrina tenha sido proibida em muitos países. O objetivo deste estudo foi avaliar o perfil de toxicidade à exposição oral de 28 dias à associação de p-sinefrina, efedrina, salicina e cafeína (na proporção de 10:4:6:80 m/m respectivamente) em ratos Wistar machos e fêmeas. Diariamente, os animais foram observados quanto ao peso corporal, sinais de toxicidade, morbidade e mortalidade. Após 28 dias, os animais foram sacrificados e o sangue coletado para avaliações hematológicas, bioquímicas e de estresse oxidativo. Não se observaram sinais clínicos de toxicidade, tampouco perda significativa de peso, mortes, ou quaisquer alterações significativas nos parâmetros hematológicos. Biomarcadores do estresse oxidativo e bioquímicos mostraram peroxidação lipídica, danos renais e hepáticos (p < 0,05; ANOVA/Bonferroni) em ratos machos (100 e 150 mg/kg) e a redução (p < 0,05; ANOVA/Bonferroni) nos níveis de glutationa reduzida (GSH) em todos os grupos de machos tratados. Nas fêmeas, não houve indícios de estresse oxidativo, nem alterações bioquímicas. O diferente perfil de toxicidade entre os gêneros sugere influência hormonal nos efeitos de mistura administrada. A associação testada pode alterar o estado oxidativo e promover danos renais e hepáticos.

Intervenções nutricionais na promoção da perda de peso: faseolamina - revisão sistemática com metanálise e alimentos com possíveis benefícios - revisão sistemática para construção de tecnologia educacional / Nutritional interventions in weight loss promotion: phaseolamine - systematic review with meta-analysis and foods with possible benefits - systematic review for building educational technology

A obesidade é uma doença crônica não transmissível e considerada epidemia mundial com prevalência alarmante. Está associada à morbimortalidade e é fator de risco para doença cardiovascular (DCV), diabetes mellitus tipo 2 (DM2), hipertensão arterial sistêmica(HAS), dislipidemias, osteoartrite e alguns tipos de câncer. As Diretrizes Brasileiras de Obesidade 2009/2010 da Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica referem ser pequeno o número de estudos que comprovem os efeitos termogênicos, anorexígenos ou redutores de peso de suplementos nutricionais de cafeína e capsaicina e mencionam poucos alimentos. No entanto a mídia cita rotineiramente vários alimentos como tratamento consolidado para perda de peso, sem que existam evidências científicas que suportem esta indicação. Com o objetivo de elaborar uma tecnologia educacional para indivíduos obesos de um hospital universitário, com esclarecimento sobre intervenções nutricionais efetivas para promoção da perda de peso foram conduzidas duas revisões sistemáticas. A busca de referências foi feita nas Bases eletrônicas ­ Pubmed, Cochrane Central de Ensaios Clínicos, Cinhal e Lilacs. Uma das revisões incluiu metanálise de ensaios clínicos randomizados sobre a utilização da faseolamina na promoção de perda ponderal e redução de massa gorda. A outra revisão incluiu apenas revisões sistemáticas com metanálise avaliando a efetividade de alimentos ou substâncias extraídas destes na promoção da perda de peso. Na metanálise foram incluídos 5 ensaios clínicos. A perda ponderal foi maior e estatisticamente significativa com a utilização da faseolamina -1,70Kg (IC de -2,44 a -0,97) e também a redução de massa gorda foi superior e estatisticamente significativa nos pacientes tratados com faseolamina -1,85Kg (IC de -2,49 a -1,21). Na outra revisão sistemática foram incluídos 7 artigos ,4 sobre chá verde ( na forma de infusão ou como suplemento), 2 sobre pimenta vermelha ( nos alimentos ou como suplemento) e 1 sobre peixes fonte de ômega 3 ou suplemento de ômega 3. De acordo com o resultado da metanálise, o uso da faseolamina promove perda ponderal e de massa gorda em pacientes obesos e com sobrepeso. A utilização da faseolamina é alternativa auxiliar no tratamento da obesidade. Considerando a revisão sistemática, a utilização de peixes fonte de ômega 3 pode auxiliar a perda de peso, assim como o consumo de pimenta vermelha em dosagem de pelo menos 2mg/dia de capsaicina antes das refeições. O consumo de chá verde não promoveu perda de peso clinicamente relevante. O presente estudo levou a elaboração de uma tecnologia educacional descrita como uma cartilha, para ser utilizada na educação em saúde da população obesa, com orientações no tratamento da obesidade e foi intitulada "Perda de Peso: Alimentos e Fitoterápicos que realmente podem ajudar você"

Obesity is a chronic nontransmissible disease that is considered a worldwide epidemic with alarming prevalence. It is associated with morbidity and mortality and is a risk factor for cardiovascular disease (CVD), diabetes mellitus type 2 (DM2), systemic hypertension (SHT), dyslipidemias, osteoarthritis and some types of cancer. Brazilian Obesity Guidelines 2009/2010 of the Brazilian Association for the Study of Obesity and Metabolic Syndrome report that there is a scarcity of studies that confirm the thermogenic, anorexigenic and weight reducing effects of nutritional supplements of caffeine and capsaicin and mention few food items. However, the media routinely cites a number of foods as treatment for weight loss, with no scientific evidence to support these allegations. Two systematic reviews were conducted to create an educational technology for obese individuals from a university hospital, with information about effective nutritional interventions that promote weight loss. The search for references was carried out in the following electronic databases: Pubmed, Cochrane Central Register of Controlled Trials, Cinhal and Lilacs. One of the reviews included meta-analysis of randomized clinical trials on the use of phaseolamin to promote weight loss and a reduction in fat mass. The other review involved only systematic reviews with meta-analysis, assessing the effectiveness of foods or substances extracted from them in the promotion of weight loss. Meta-analysis included 5 clinical trials. Weight loss was greater and statistically significant with the use of phaseolamin -1.70Kg (CI between -2.44 and -0.97) and the reduction in fat mass was higher and statistically significant in patients treated with phaseolamin -1.85Kg (CI between -2.49 and -1.21). The other systematic review involved 7 articles, 4 on green tea (in the form of infusion or a supplement), 2 on red pepper (in food or as supplement) and 1 on omega-rich fish or omega 3 supplement. According to the results of meta-analysis, the use of phaseolamin promotes weight and fat mass loss in obese and overweight patients. The use of phaseolamin is an auxiliary alternative in the treatment of obesity. The systematic review revealed that the use of omega 3-rich fish can contribute to weight loss, as well as consuming red pepper in a dose of at least 2mg/dia of capsaicin before meals. Green tea intake did not promote clinically relevant weight loss. The present study led to the creation of an educational technology in the form of a booklet, to be used in health education for obese individuals, with orientation regarding the treatment of obesity, and entitled "Weight Loss: Foods and Phytotherapics that can really help you"

The effect of weight reduction on antioxidant enzymes and their association with dietary intake of vitamins A, C and E / Efeito da redução de peso sobre as enzimas antioxidantes e associação destas com a ingestão de vitaminas A, C e E

Objective Our goal was to assess the effects of weight loss on antioxidant enzymes of red blood cells and it’s relation with vitamins A, E and C intake in 30 obese women. Subjects and methods General information, anthropometric measurements, 3-day food recall, and fasting blood samples were collected from 30 obese women at the beginning of the study and after 3 months intervention. Weight loss was set at about 10% of their weight before the intervention. Results Glutathione reductase and catalase activities showed a significant increase (P < 0.01) after weight reduction, but no significant changes were seen in the superoxide dismutase and glutathione peroxidase activities. There was a positive linear correlation between daily vitamin C intake with superoxide dismutase enzyme after intervention (P = 0.004, r = 0.507). There was a negative linear correlation between vitamin E intake and glutathione peroxidase activity before intervention (P = 0.005, r = -0.5). A negative correlation was found between daily vitamin A intake and glutathione reductase enzyme before and after intervention (r = -0.385, r = -0.397, P < 0.05) respectively. No significant correlation was observed between vitamins A, C, E amounts and catalase activity. Conclusions Ten percent weight reduction can have a significant role in increasing antioxidant enzymes activities, especially glutathione reductase, and catalase enzymes in obese women. However, it is important to take into consideration a balanced amount of certain nutrients while administering a diet with limited energy. .

Objetivo Nosso objetivo foi avaliar os efeitos da perda de peso sobre as enzimas antioxidantes de eritrócitos, e a relação destas com a ingestão das vitaminas A, E e C. Sujeitos e métodos Foram coletadas informações gerais e medidas antropométricas, registro alimentar de três dias e amostras de sangue em jejum de 30 mulheres obesas no início do estudo e depois de três meses da intervenção. A perda de peso determinada antes da intervenção foi de 10% do peso. Resultados As atividades da glutationa redutase e da catalase mostraram aumento significativo (P < 0,01) depois da perda de peso, mas não houve mudanças significativas nas atividades da superóxido dismutase e da glutationa peroxidase. Foi observada uma correlação linear positiva entre a ingestão diária de vitamina C e a enzima superóxido dismutase após a intervenção (P = 0,004, r = 0,507). Houve uma correlação linear negativa entre a ingestão de vitamina E e a atividade da glutationa peroxidase antes da intervenção (P = 0,005, r = -0,5). Foi observada uma correlação negativa entre a ingestão diária de vitamina A e a enzima glutationa redutase antes e depois da intervenção (r = -0,385, r = -0,397, P < 0,05), respectivamente. Não foram observadas correlações significativas entre as vitaminas A, C, E e os níveis e a atividade da catalase. Conclusões Uma redução de 10% no peso pode ter um papel significativo no aumento da atividade das enzimas antioxidantes, especialmente na glutationa redutase e catalase em mulheres obesas. Entretanto, é importante levar em consideração uma ingestão equilibrada de certos nutrientes ao se recomendar uma dieta com níveis de energia restritos. .

O efeito da sibutramina na perda de peso de adolescentes obesos / The effect of sibutramine on weight loss in obese adolescents

Objetivo : Avaliar o efeito da sibutramina na perda de peso de adolescentes obesos.Sujeitos e métodos : Estudo duplo-cego placebo controlado tipo cross over com duração de 13 meses. Foram incluídos no estudo 73 adolescentes obesos de ambos os sexos com idades entre 10 e 18 anos. A avaliação antropométrica foi realizada a cada 40 dias em média. Os exames laboratoriais e de imagem foram realizados antes, no período de wash-out e ao final dos 13 meses.Resultados : A porcentagem de pacientes que perderam 10% do peso inicial no placebo foi de 46% e, no grupo sibutramina, foi de 75%. Quando usaram o placebo, o peso em média se elevou em 1,61 kg, e o IMC reduziu em média 0,24 kg/m2, enquanto com o uso da sibutramina o peso reduziu em média 4,47 kg e o IMC reduziu em média 2,38 kg/m2 com p < 0,001.Conclusões : A sibutramina induziu significantemente mais perda de peso em adolescentes obesos em comparação ao placebo, sem efeitos colaterais significativos. A curva de evolução ponderal foi diferente de acordo com o momento em que a sibutramina foi introduzida. Esse achado indica que o melhor momento de introdução da sibutramina é quando a adesão começa a falhar. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Objective : To evaluate the effect of sibutramine on weight loss in obese adolescents.Subjetcs and methods A double-blind controlled study lasting 13 months. The study included 73 obese adolescents of both sexes aged between 10 and 18 years. Laboratory tests and imaging studies were performed before, during wash-out, and at the end of 13 months.Results : The percentage of patients who lost 10% of their initial weight in the placebo group was 46%, and in the sibutramine group was 75%. When placebo was used, average weight rose by 1.61 kg, and BMI decreased by 0.24 kg/m2 whereas with the use of sibutramine, weight decreased by 4.47 kg, and average BMI decreased, 2.38 kg/m2, with p < 0.001.Conclusions : Sibutramine induced significantly more weight loss in obese adolescents compared with placebo, without significant side effects. The weight loss curve was different depending on the moment sibutramine was introduced. This finding indicates that the best time to start sibutramine is when adhesion begins to fail. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Successful treatment of enteropathy associated with common variable immunodeficiency

No abstract available.

Prevalence of weight-loss strategies and use of substances for weight-loss among adults: a population study / Prevalência de estratégias de emagrecimento e uso de substâncias para perder peso entre adultos: um estudo populacional

This paper concerns a cross-sectional population-based study conducted with adults living in the city of Pelotas, Rio Grande do Sul State, Brazil. It aims to determine the prevalence of weight-loss practices and use of substances for weight-loss during the 12 months preceding the interview. The prevalence of weight-loss attempts was 26.6%. Although dietary control and regular physical exercise were the most commonly used strategies, the prevalence of the combined use of these methods was only 36% for individuals trying to lose weight. The prevalence of use of substances for weight-loss was 12.8% (48.4% of those who tried to lose weight). The use of dietary control and substances was more common among women, while men practiced physical exercise with greater frequency. Teas were the most frequently used substances for weight-loss. Multivariate analysis identified being female, excess weight and self-perception of excess weight as major associated factors for the use of substances for weight-loss. Finally, we found that, although weight-loss attempts are common, the majority of obese individuals do not make attempts to lose weight and only a minority follows the recommended practices.

Estudo transversal de base populacional conduzido com adultos residentes na cidade de Pelotas, Rio Grande do Sul, Brasil, que objetivou determinar a prevalência de práticas de emagrecimento e uso de substâncias para emagrecer, nos últimos 12 meses antes da entrevista. A prevalência de tentativas de emagrecimento foi de 26,6%. Controle dietético e prática regular de exercícios físicos foram as estratégias mais frequentes, mas apenas 36% daqueles que tentaram emagrecer combinaram-nas. A prevalência do uso de substâncias para emagrecer foi de 12,8% (48,4% daqueles que tentaram emagrecer). Mulheres utilizaram controle dietético e substâncias mais frequentemente do que homens, enquanto estes utilizaram mais exercícios físicos. As substâncias de uso mais frequente foram os chás. A análise ajustada identificou sexo feminino, excesso de peso e percepção do excesso de peso como os maiores fatores associados ao uso de substâncias. Assim, identificamos que tentativas de emagrecimento são frequentes, porém, não são referidas pela maioria dos obesos e apenas uma minoria daqueles que tentam emagrecer segue as práticas recomendadas.

Hypoglycemic effects of an aqueous extract of Bauhinia forficata on the salivary glands of diabetic mice

The objective of this study was to evaluate the salivary glands in diabetic mice, analyzing alterations in the secretory epithelium and interactions with the stromal compartment acquired during a prolonged period of treatment with Bauhinia forficata extract. Female mice were divided into two groups: Nonobese diabetic [NOD] mice treated with Bauhinia forficata [I], and NOD mice not treated with the hypoglycemic agent [II]. After treatment, the salivary glands were collected for analysis by transmitted and polarized light microscopy, complemented by three-dimensional analysis of these tissues. The results showed weight loss in animals of group II and weight recovery in treated animals. Glucose levels were elevated in group II, but declined in group I. In the two groups, the salivary glands were characterized by involution of the secretory epithelium, presence of an inflammatory infiltrate and an increase of extracellular fibrillar components. It can be concluded that treatment with Bauhinia forficata reduced glucose levels and contributed to weight recovery in treated animals. However, the observation of tissue destructuring and compromised epithelial-stromal interactions, with consequent impairment of glandular function, demonstrates that Bauhinia forficata exerts an effect on the recovery of body metabolism but this improvement does not influence in the tissue recovery

Changes of Body Weight and Inflammatory Markers after 12-Week Intervention Trial: Results of a Double-Blind, Placebo-Control Pilot Study

PURPOSE: Low grade inflammation is a well-known characteristic in obese subjects. We investigated body weight changes and inflammatory markers after 12-week intervention trial. MATERIALS AND METHODS: Twenty-six obese subjects were enrolled and 19 (13 men and 6 women) completed the study. Sibutramine is an FDA-approved drug for body weight control; therefore, we chose this drug as the standard treatment medication in this study. Patients were randomly allocated to receive an anti-inflammatory agent (Diacerein treatment group; n = 12) or placebo (n = 7) for 12 weeks. Anthropometry, body proportion by dual-energy X-ray absorptiometry, and metabolic parameters at the beginning and end of study were measured and compared. RESULTS: The treatment group had a tendency towards more reduction in anthropometry as compared to the placebo group, in body weight reduction (- 7.0 kg vs. - 4.6 kg), body mass index (- 2.51 kg/m2 vs. - 1.59 kg/m2), and waist circumference (- 7.3 cm vs. - 4.4 cm). These reductions were not statistically significant. Changes in levels of high-sensitivity C-reactive protein and adiponectin in the treatment group were more favorable than in the placebo group. CONCLUSION: This small pilot study showed no statistical difference for changes in anthropometry, and inflammatory markers between the two groups. Therefore, we could not find any additional effects of Diacerein on weight loss and inflammatory variables in this study.

Breaking the vicious circle of obesity: the metabolic syndrome and low testosterone by administration of testosterone to a young man with morbid obesity / Quebrando o círculo vicioso da obesidade: síndrome metabólica e baixos níveis de testosterona pela administração de testosterona a um homem jovem com obesidade mórbida

OBJECTIVE: The metabolic syndrome (MS) is associated with low serum testosterone levels. Conversely, low testosterone levels induce MS. These operational mechanisms reinforce one another and induce a vicious cycle. This is a report on a morbid obesity 42 year-old man with the MS and serum testosterone of 5.0 nmol/L (N: 12.0-33.0), who was resistant to treatment with diet and exercise. He was treated with testosterone undecanoate for 16 months. METHODS: Anthropological and laboratory variables were measured before and during testosterone administration. Also the Aging Male Symptom Scale (AMS), the International Index of Erectile Function (IIEF) and Beck's Depression Inventory were assessed. RESULTS: After 16 months, there was a weight loss of 50 kg and a decrease in waist circumference of 36.5 cm. Blood pressure normalized and laboratory variables returned to the normal range. The patient did not meet the criteria for the MS anymore. There were improvements on the AMS, the IIEF and Beck's Depression Inventory. CONCLUSIONS: Normalizing testosterone in men with morbid obesity in combination with diet and exercise, with the MS and low testosterone levels, may rescue them from the MS, improving their mood and their stamina to follow a diet and to exercise.

OBJETIVO: A síndrome metabólica (SM) está associada a baixos níveis séricos de testosterona. Inversamente, baixos níveis de testosterona induzem a SM. Esses mecanismos operacionais se reforçam mutuamente e levam a um círculo vicioso. Este é o relato de um homem de 42 anos, obesidade mórbida com SM e testosterona sérica de 5,0 nmol/L (N: 12,0-33,5), resistente ao tratamento com dieta e exercícios. Ele foi tratado com undecanoato de testosterona por 16 meses. MÉTODOS: Variáveis antropológicas e laboratoriais foram medidas antes e durante a administração de testosterona. Também foram avaliados a Escala de Envelhecimento Masculino (AMS), o Índice Internacional de Função Erétil (IIEF) e a Escala de Beck para Depressão. RESULTADOS: Após 16 meses, houve uma perda de peso de 50 kg e diminuição de 36,5 cm da circunferência abdominal. A pressão arterial foi normalizada e as variáveis laboratoriais também retornaram para os limites de normalidade. O paciente não preenchia mais os critérios para SM. Houve melhoras da AMS, do IIEF e da Escala de Beck para Depressão. CONCLUSÕES: A normalização da testosterona em homens com obesidade mórbida, combinada à dieta e a exercícios, com SM e baixos níveis de testosterona, pode livrá-los da SM, melhorando o humor e o vigor para seguir uma dieta e exercícios.

Revisão sistemática de dietas de emagrecimento: papel dos componentes dietéticos / Systematic review of weight loss diets: role of dietary components

O excesso de peso corporal é o sexto mais importante fator de risco para doenças crônicas não transmissíveis. Inúmeras publicações foram produzidas nos últimos anos para avaliar a melhor alternativa para perda de peso. O objetivo desta revisão sistemática foi analisar criticamente o papel dos componentes dietéticos (macronutrientes e/ou alimentos) nas dietas de emagrecimento para indivíduos adultos descritas recentemente na literatura. Foram selecionados ensaios clínicos randomizados com pelo menos um ano de acompanhamento publicados no MedLine (língua portuguesa, inglesa e espanhola) de 2004 a 2009. Dos 23 estudos com diferentes tipos de dietas, 13 apresentaram taxa de abandono > 25 por cento em pelo menos uma das dietas. Em conclusão, nos estudos em que a perda ponderal foi > 5 por cento do peso inicial, essa perda foi associada à restrição de energia proveniente da dieta. Além disso, o seguimento de dieta com restrição de carboidratos ou mediterrânea poderia representar uma alternativa à restrição energética, devendo esses dados ainda ser confirmados.

Being overweight is the sixth most important risk factor for chronic non-transmissible diseases. Many publications have been produced in recent years to evaluate the best weight loss alternative. The aim of this systematic review was to critically assess the role of dietary components (macronutrients and/or foods) in weight loss diets in adults recently described in the literature. Randomized clinical trials, with at least one year of follow-up, were selected in MedLine (in Portuguese, English and Spanish languages) from 2004 to 2009. Among the 23 studies included with different types of diets, 13 presented a rate of withdrawal from the study > 25 percent in at least one of the diets. In conclusion, most diets where the weight loss was > 5 percent of initial weight were energy restricted. Furthermore, following low carbohydrate or Mediterranean diets can be an alternative to isolated energy restriction, but these data are yet to be confirmed.

The first decade of sibutramine and orlistat: a reappraisal of their expanding roles in the treatment of obesity and associated conditions / A primeira década da sibutramina e do orlistate: reavaliação do seu crescente papel no tratamento da obesidade e condições associadas

Ancillary therapies for weight management, consisting mainly of diet and exercise programs that incorporate variable levels of lifestyle modification techniques, are frequently ineffective to achieve clinically meaningful weight loss and maintenance. Although pharmacological treatment of obesity is widely used in most countries, the number of available drugs is still very limited. The most widely used anti-obesity agents are sibutramine and orlistat, both available in clinical practice for about a decade. A large number of clinical trials have demonstrated that both agents are safe and well tolerated, with a level of efficacy in the moderate weight loss recommended by the most relevant clinical guidelines. Several studies have assessed the efficacy and safety of sibutramine and orlistat in adolescents and also for the treatment of some associated conditions in adults, including type 2 diabetes, polycystic ovary syndrome and binge eating disorder. The positive results of these studies suggest an expanding role for both agents, not only for the treatment of obesity, but also for associated conditions. After the efficacy of orlistat for the prevention of type 2 diabetes demonstrated in the XENDOS study, the results of SCOUT study are awaited for a better evaluation of sibutramine impact on cardiovascular outcomes.

A terapia anciã para controle do peso, que consiste principalmente em programas de dieta e exercício incorporando técnicas de mudança de estilo de vida de diversos níveis distintos, é frequentemente ineficaz em atingir uma perda e manutenção de peso clinicamente significativas. Apesar de amplamente utilizado na maioria dos países o tratamento farmacológico da obesidade, o número de medicamentos disponíveis ainda é muito limitado. Os agentes antiobesidade mais utilizados são a sibutramina e o orlistate, ambos disponíveis na prática clínica há cerca de uma década. Em um grande número de ensaios clínicos já se demonstrou que ambos agentes são seguros e bem tolerados, com um nível de eficácia consistente de perda de peso moderada que se recomenda nas principais diretrizes clínicas. Vários estudos avaliaram a eficácia e segurança da sibutramina e do orlistate em adolescentes e também para o tratamento de algumas condições associadas em adultos, incluindo o diabetes tipo 2, a síndrome dos ovários policísticos e o transtorno da compulsão alimentar periódica. Os resultados positivos desses estudos sugerem que o papel dos dois medicamentos deverá ser expandido não apenas para o tratamento de um maior número de pacientes obesos, mas também para o tratamento de condições associadas. Depois que o orlistate teve sua eficácia demonstrada na prevenção do diabetes tipo 2 por meio do estudo XENDOS, os resultados do SCOUT são aguardados para uma melhor avaliação do impacto da sibutramina sobre os desfechos cardiovasculares.

Characterization and application of extracted natural polymer fiber [aminopolysaccharide] as weight reducing agent

Chitosan has some specific role in the folk medicine in controlling body weight. The present work aims to investigate the effect of the chitosan potency to control the body weight in all male albino rats. In the present work chitin was obtained from the shells, from waste materials of the sea food such as crustaceans and shrimp. The chitosan types F85 and F95 of different degrees of deactylation were produced by chemical treatment of chitin. The produced chitosan types were mixed with a certain ratio of ascorbic acid and applied to study the effect of them as a weight reducing supplement. The physical properties measurements were carried out. The results indicated that, the chitosan type F95 gives the best results. as a weight reducing supplement

Lead intoxication causing loss of body weight and loss of absolute weight of testes in albino rats

Lead intoxication produces metallic taste, thirst, nausea, vomiting, anorexia, constipation, and which result in weight loss. The direct effect of lead on testes causes degeneration and necrosis of organ which leads to loss of absolute testicular weights. With loss of body weights also result loss of relative weights of organ as systemic consequences. Experimental study. Anatomy Department, Basic Sciences Medical Institution, Jinnah Postgraduate Medical Centre, Karachi. Forty adult Albino Rats were selected for the study and divided into two groups. Group A served as control group and received injection normal saline 1 ml intraperitoneally daily for eight weeks. Group B was lead treated group and received lead chloride in a dose of 10 mg/kg body weight intraperitoneally daily for eight weeks. Animals were weighed at the commencement and at the completion of treatment. Absolute weights of testes were recorded after animals sacrificed. Relative weights of testes were also calculated. The results were compared with control and correlated with the previous studies[1,2,9]. Final body weight of animals was decreased significantly [P<0.001] in group B as compared to group A. Absolute Weight of testes was significantly decreased [P<0.001] in group B as compared to group A. Relative Weight of testes was significantly decreased [P<0.001] in group B as compared to group A. Lead toxicity is causing loss of body weight of animals. The direct effect of lead on testes produces degeneration and necrosis of testes result in absolute loss of weight of testes. The loss of generalized body weight results in loss of relative weight of organ

Impact of weight loss on adipocytokines, C-reactive protein and insulin sensitivity in hypertensive women with central obesity / Impacto da perda de peso nas adipocitocinas, na proteína C-reativa e na sensibilidade à insulina em mulheres hipertensas com obesidade central

OBJETIVO: Avaliar o impacto do tratamento da obesidade nas adipocitocinas, na proteína C-reativa (PCR) e na sensibilidade à insulina em pacientes hipertensas com obesidade central. MÉTODOS: O estudo foi realizado a partir do banco de dados e de amostras estocadas de soro de pacientes submetidas previamente a um estudo para tratamento de obesidade. Foram selecionadas 30 mulheres hipertensas, com idade entre 18 e 65 anos, índice de massa corpórea (IMC) > 27 kg/m², com distribuição central de gordura. As pacientes foram aleatoriamente submetidas a dieta hipocalórica e orlistat 120 mg três vezes por dia ou apenas a dieta hipocalórica, durante 16 semanas. As pacientes que apresentaram perda de peso superior a 5 por cento (n = 24) foram avaliadas em relação a níveis pressóricos, valores antropométricos, gordura visceral, índices de resistência (HOMA-R - homeostasis model assessment of insulin resistance) e de sensibilidade à insulina (ISI - Insulin Sensitivity Index), perfil lipídico, e dosagens das adipocitocinas (adiponectina, leptina, IL-6 e TNF-a) e de PCR. RESULTADOS: Após redução do IMC de cerca de 8 por cento em ambos os grupos, foi verificada diminuição de gordura visceral, glicemia de jejum, triglicérides e TNF-a. Apenas o grupo orlistat, que inicialmente era mais resistente à insulina, apresentou redução significativa da glicemia pós-sobrecarga oral de glicose e aumento da sensibilidade à insulina. CONCLUSÃO: Os achados deste estudo indicam que a perda de peso superior a 5 por cento se associa à melhora do perfil inflamatório e à redução da resistência à insulina, a qual ocorreu de maneira independente das variações de adiponectina e de TNF-a. Os maiores benefícios na sensibilidade à insulina obtidos no grupo orlistat não puderam ser atribuídos ao uso do medicamento em virtude da maior concentração de indivíduos resistentes à insulina nesse grupo.

OBJECTIVE: To assess the impact of weight reduction on serum adipocytokines, C-reactive protein (CRP), and insulin sensitivity in hypertensive female patients with central obesity. METHODS: This study was performed using the database and stored serum samples of female patients who had participated in an intervention study focused on weight loss. Thirty hypertensive women aged 18 to 65, body mass index (BMI) > 27 kg/m², and central obesity were selected. They were randomly assigned to receive either a low-calorie diet plus orlistat 120 mg three times daily or a low-calorie diet alone for 16 weeks. Patients who experienced weight loss greater than 5 percent (n = 24) were assessed for blood pressure, anthropometric parameters, visceral fat, insulin resistance (HOMA-R - homeostasis model assessment of insulin resistance) and sensitivity (ISI - Insulin Sensitivity Index) indices, plus serum lipids, adipocytokines (adiponectin, leptin, IL-6, and TNF-a) and CRP levels. RESULTS: After BMI had been reduced by approximately 5 percent in both groups, visceral fat, fasting glucose, triglycerides, and TNF-a decreased. Only the orlistat group, which was more insulin resistant at baseline, showed a significant reduction in blood glucose after oral glucose load, in addition to increased insulin sensitivity. CONCLUSION: This study's findings indicate that a weight loss greater than 5 percent is associated with improved inflammatory status and decreased insulin resistance, regardless of changes in adiponectin and TNF-a levels. The greatest improvements in insulin sensitivity experienced by the orlistat-treated patients could not be attributed to the use of this drug because of the higher number of insulin-resistant subjects in this group.