Obesity-related knowledge and body mass index: a national survey in Portugal.

PURPOSE: Obesity-related knowledge predicts weight control but previous studies only comprise individuals with excessive weight and assess very specific aspects of knowledge. This study aims to evaluate several domains of obesity-related knowledge according to the body mass index (BMI) in a representative sample of Portuguese-speaking dwellers in mainland Portugal. METHODS: A sample of 1624 participants aged 16-79 years was analyzed. Eighteen questions comprising eight obesity domains were asked: prevalence, physical activity, number of calories, adiposity location, causes, diagnosis, treatment and consequences; each one was dichotomized into correct/incorrect knowledge. RESULTS: The majority of Portuguese-speaking dwellers recognized the benefits of physical activity, the risks of abdominal obesity and most consequences of excessive weight, independently of their BMI. However, knowledge gaps were identified regarding prevalence, calories and BMI diagnosis. BMI influenced specific obesity-related knowledge: participants with a normal BMI knew the BMI formula more often, identified 22 as normal BMI more frequently and had the highest proportion of correct knowledge regarding the number of calories an adult should eat; obese individuals identified natural products as not being good treatments for obesity more often. After adjusting for age, sex and educational level, obese individuals identified natural products and supplements as not being good obesity treatments more often. CONCLUSIONS: Obesity-related knowledge gaps (prevalence, calories, and diagnosis) were identified among Portuguese adults. Moreover, correct knowledge does not necessarily translate into a healthier BMI. Besides the dissemination of accurate information, public health interventions should focus on the transfer of knowledge to behaviors that will guarantee better weight management. EVIDENCE-BASED MEDICINE RANKINGS: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Is there a role for salvage radiotherapy in locally advanced breast cancer refractory to neoadjuvant chemotherapy?

INTRODUCTION: Locally advanced breast cancer (LABC) is a major problem, especially in developing countries. The standard treatment for LABC is neoadjuvant chemotherapy, with or without anti-Her2 therapy, followed by surgery, radiotherapy, and adjuvant systemic treatment if appropriate. However, there are few data in the literature addressing alternatives when neoadjuvant chemotherapy fails to reduce the tumour for surgery. MATERIALS AND METHODS: We conducted a retrospective study including all patients who had non-metastatic LABC treated with neoadjuvant chemotherapy and who were not eligible for surgical resection; these patients were submitted to salvage radiotherapy (RTX) between January 2000 and December 2012 at the Brazilian National Cancer Institute. RESULTS: Fifty-seven patients were included, with a median age of 51 (23-72) years. The most frequent clinical stages were IIIA and IIIB, corresponding to 19.3% and 70.2%, respectively; mean tumour size was 8.74 (3-18) cm, and 44 patients (77.2%) had nodal involvement. Chemotherapeutic regimens containing anthracyclines were prescribed to 98.2% of the patients. Fifteen patients (26.3%) received taxanes and anthracyclines. Radiation dose was 50 Gy divided into 25 fractions; 43 patients (75.4%) had their tumours downsized by RTX and underwent mastectomy. Overall survival (OS) was 38 (23-52) months. Patients who were submitted to surgery had an OS of 49 (28-70) months and those who were not eligible for mastectomy after radiotherapy had an OS of 18 (9-27) months. CONCLUSION: This retrospective study confirms that RTX is an effective treatment to downsize LABC tumours with low or no response to chemotherapy, thereby enabling surgical resection which may improve overall patient outcome.

Overweight and obesity in Portugal: national prevalence in 2003-2005.

Obesity is an endemic health problem in most developed countries, requiring serious public health attention. The first Portuguese nationwide representative survey about obesity (with objective anthropometric measurement) was undertaken from 1995 to 1998. This paper presents data coming from the second and most recent nationwide representative study of obesity, with objective measurement of weight, height, waist and hip circumferences. Data were collected between January 2003 and January 2005. The survey collected objective body mass index (BMI) values of 8116 participants aged 18-64. Main findings were: 2.4% of the sample had low weight (BMI < 18.5), 39.4% were overweight (BMI between 25.0 and 29.9), and 14.2% obese (BMI > or = 30). Waist circumference measurement showed that 45.6% of the sample suffers increased cardiovascular health risks associated with high waist circumference. The overall overweight/obesity prevalence increased from 49.6% (in 1995-1998) to 53.6% (in 2003-2005). These data suggest that although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date. Well-defined public health intervention must be targeted to specific population groups where higher levels of obesity prevalence were found: low socioeconomic level groups and low-education level groups.

Prevalence of obesity in Portugal.

Obesity is a serious health problem in developed countries. Knowledge of reliable and nationwide representative data is a must for any public health action. The dimension of this problem in Portugal was first assessed in 1995-1998. A similar populational survey using objective anthropometric measures is now being conducted (field work started in January 2003). A total of 6411 subjects aged 18-64 years old have already been measured and their respective body mass indexes (BMIs) calculated. Results from 2003 to 2005 show 38.6% is overweight and 13.8% has obesity. The total of overweight and obesity is 52.4%. In 1995-1998 survey, overweight was 35.2% and obesity was 14.4%. The total was 49.6%. These results suggest an increase of the overweight/obesity (altogether) prevalence in the last 10 years. Actual results show that more than half of the adult sample has excessive weight and 2.4% of the sample has low BMI. Finally, 45.6% of the sample suffers increased health risks because of high waist circumference (> or =80 cm for women; > or =94 cm for men). These results highlight the fact that, although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date.

[Epidemiology of anorexia nervosa. Prevalence of anorexia nervosa in female adolescents from the districts of Lisboa and Setubal]. / Epidemiologia da anorexia nervosa. Prevalência da anorexia nervosa em adolescentes do sexo feminino nos distritos de Lisboa e Setúbal.

UNLABELLED: Prevalence studies of anorexia nervosa (AN) have shown differences depending of the country and method applied. The partial syndrome is being emphasized. There has been no epidemiological study done on AN in the Portuguese population of continental Portugal. Our objectives were: 1) to study the prevalence of AN in Portuguese populations; 2) to study the presence of partial syndrome and of body image disturbance; 3) to calculate the number of girls dieting; 4) to correlate with other variables. A population of 2,398 girls ranging 10 to 21 years old, from 30 State secondary schools in the Lisbon and Setubal districts were studied. A questionnaire was answered with questions allowing assessment of all DSM IIIR criteria for AN. RESULTS: Prevalence of AN--0.37%, partial syndrome--12.6%, body image disturbance without weight loss--7%, wish to decrease weight in normal or low weight girls--38%, overweight--15.3%, the peak of age for AN was 15 years, the most prevalent socio-economic class for AN was 2 (scale 1 (higher) to 5). School performance was worse with AN and the age menarche was sooner.

[Health behaviors in Portugal. Epidemiological studies]. / Comportamentos na saúde em Portugal. Alguns estudos epidemiológicos.

It is necessary to evaluate habitudes and behaviours in health in Portugal. The purpose of this review is to analyse some portuguese epidemiological studies. CINDI-Portugal, ERICA-Portugal and the National Health Inquiry were national studies regarding multiple health data. Nutritional attitudes and practices have been evaluated since 1940. The National Food Study and the Study of Prevalence of Obesity in Portugal studied Portuguese nutritional attitudes. There are studies of the prevalence of eating disorders i school populations. Some research about the association between food and disease is reported. The Portuguese Food Balance is reviewed. Some methodological problems are pointed out and the results discussed. The results of Portuguese studies suggest that our country is in danger of errors in the course of consumption attitudes.

[Characterization of leukocytes, lymphocytes and lymphocyte subsets in eating disorders]. / Caractérisation des leucocytes, lymphocytes et populations lymphocytaires dans les maladies du comportement alimentaire.

Mental anorexia patients have severe denutrition and high cortisol levels. Nervous bulimia presents a particular psychic profile. The aim of this study was to evaluate lymphocyte population in eating disorders in order to understand the effect of these disturbances on immune system. We have found that patients with mental anorexia or bulimia present a significant decrease of leucocytes, lymphocytes, CD2 and CD4. Patients with post-anorexia bulimia have no significant variants. There is no difference between mental anorexia and nervous bulimia. There is a tendential variation between mental anorexia and controls in relation to CD45Ra. Considering the similar patterns of immune disturbance in anorexia and bulimia it looks like a dominance of neuroimmune network over malnutrition. Naive cells are particularly sensitive to malnutrition.

[Obesity and dyslipidemia. Nature of an association]. / Obesidade e dislipidemia. Natureza de uma associação.

Obesity is commonly associated with hyperlipidemia on the basis of clinical and epidemiological studies, but the mechanisms of that relationship are not well understood. To evaluate the contribution of obesity to fasting levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), we retrospectively analyzed data of 209 patients (175 women and 34 men) attending our outpatient clinic to lose weight. Hyperlipidemia, namely hypertriglyceridemia and low levels of HDL-C, was more frequent in more advanced grades of obesity. Fifty per cent of men with moderate obesity were found to have hypertriglyceridemia and 41.6% showed low levels of HDL-C. However, the relationship between obesity and hyperlipidemia is confounded by age and is not significant when body mass index (BMI) is correct for age. After this correction, we only found a significant correlation (r = 0.93, p = 0.01) between BMI and hypertriglyceridemia in female patients. We conclude that hyperlipidemia and obesity are associate but their relationship is weak and influenced by age. Also important in this relationship seems to be the distribution of body fat.