Habits and Persistent Food Restriction in Patients with Anorexia Nervosa: A Scoping Review.

The aetiology of anorexia nervosa (AN) presents a puzzle for researchers. Recent research has sought to understand the behavioural and neural mechanisms of these patients' persistent choice of calorie restriction. This scoping review aims to map the literature on the contribution of habit-based learning to food restriction in AN. PRISMA-ScR guidelines were adopted. The search strategy was applied to seven databases and to grey literature. A total of 35 studies were included in this review. The results indicate that the habit-based learning model has gained substantial attention in current research, employing neuroimaging methods, scales, and behavioural techniques. Food choices were strongly associated with dorsal striatum activity, and habitual food restriction based on the self-report restriction index was associated with clinical impairment in people chronically ill with restricting AN. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and Regulating Emotions and Changing Habits (REaCH) have emerged as potential treatments. Future research should employ longitudinal studies to investigate the time required for habit-based learning and analyse how developmental status, such as adolescence, influences the role of habits in the progression and severity of diet-related illnesses. Ultimately, seeking effective strategies to modify persistent dietary restrictions controlled by habits remains essential.

Permanent health education in the context of obesity: a scoping review

ABSTRACT OBJETIVE To map the international literature on Permanent Health Education initiatives to care for people with obesity. METHODS In total, six databases were searched without any language or publication period restriction according to the Joana Briggs Institute manual for evidence synthesis and the Prisma extension for scoping reviews (Prisma-ScR). Articles were independently analyzed by four reviewers and data, by two authors, which were then analyzed and discussed with our research team. RESULTS After screening 8,780 titles/abstracts and 26 full texts, 10studies met our eligibility criteria. We extracted data on methodologies, themes, definitions of obesity, outcomes, and gaps. Most initiatives came from North American countries without free or universal health systems and lasted a short period of time (70%), had multidisciplinary teams (70%), and addressed sub-themes on obesity approaches (90%). Results included changes in participants' understanding, attitude, and procedures (80%) and gaps which pointed to the sustainability of these changes (80%). CONCLUSION This review shows the scarce research in the area and a general design of poorly effective initiatives, with traditional teaching methodologies based on information transmission techniques, the understanding of obesity as a disease and a public health problem, punctual actions, disciplinary fragmentation alien to the daily work centrality, and failure to recognize problems and territory as knowledge triggers and to focus on health care networks, line of care, the integrality of care, and food and body cultures.

Weight stigma in the COVID-19 pandemic: a scoping review.

BACKGROUND: Weight stigma is a phenomenon associated with adverse behavioural and psychological consequences. Although experts suggest that its increase during the COVID-19 pandemic may be associated with worse health outcomes for people with obesity, a thorough analysis of the main findings and gaps is still needed when relating to this subject. OBJECTIVE: We aim to answer three questions: (1) How does weight stigma manifest in the COVID-19 pandemic? (2) How can weight stigma affect people with overweight or obesity in times of COVID-19? (3) What are the perceptions and experiences of weight stigma during the pandemic in individuals who experience overweight or obesity? METHODS: We conducted a scoping review of studies addressing weight stigma and the COVID-19 pandemic in electronic databases (Medline/PubMed, CINAHL, Embase, PsycInfo, BVS/Lilacs, Scopus, Web of Science, Google Scholar, and OpenGrey) published until 10th August 2021. All relevant studies were reviewed in full by two researchers. In addition, a narrative synthesis of the data was performed. RESULTS: The results included 35 studies out of 8,090 records and identified 13 original research publications, 14 text and opinion papers, and 6 narrative reviews. The results revealed the presence of weight stigma in the media, healthcare settings, interpersonal relationships, and public campaigns during the COVID-19 pandemic. The evidence of increasing weight stigma in the COVID-19 outbreak is limited, though. Many weight discrimination consequences were described during this time, such as impairment in accessing healthcare, worst COVID-19 outcomes, and maladaptive eating. However, only maladaptive behaviours and decline in mental health outcomes were demonstrated empirically in all age groups. This effect occurred regardless of body mass index, but people with high body weight were more likely to experience weight stigma. For some people with obesity, weight stigma in the pandemic has made activities of daily routine difficult. CONCLUSIONS: The results suggest that weight stigma in the COVID-19 pandemic occurs in several settings; moreover, although weight discrimination impacts mental health, whether before or during the pandemic, this influence between the pandemic and pre-pandemic scenario is still unclear. Therefore, more research is required in this field while the pandemic lasts, especially with people with obesity. Overall, people with overweight or obesity are more vulnerable to weight stigma than individuals without overweight. In addition, weight stigma refers to discrimination or prejudice based on a person's weight and relates to several consequences, for instance, poor healthcare treatment and mental health problems. In the COVID-19 outbreak, these weight stigma effects tend to become even more critical because they may be associated with unfavourable COVID-19 outcomes and eating disorder risks. Thus, it is crucial to investigate how weight stigma occurs during the pandemic and its impact on health, mainly for the most affected people. We investigated 35 studies published between 2019 and 2021 to map and explore how weight stigma was manifested and the related consequences for people with overweight or obesity in the COVID-19 pandemic. Only about a third of them were quantitative or qualitative, limiting the evidence of weight stigma in the COVID-19 context. The available evidence suggests that weight stigma manifests in several settings such as media, healthcare, public campaigns, and is more common in people with excess weight. However, weight discrimination experiences before or during the pandemic were associated with adverse psychological and behavioural consequences across all age groups, regardless of body weight. For some people with obesity, for instance, weight stigma made it difficult to accomplish their activities of daily routine. Nevertheless, it remains unclear whether weight stigma has increased in the pandemic, thus, more studies are required, especially about people with overweight or obesity.

Restrained eating behaviour, anorexia nervosa and food consumption between children and adolescents: a scoping review.

Anorexia nervosa (AN) and restrained eating behaviour (REB) are characterised by reduced food intake to achieve body weight loss. This scope review aimed to describe the existing evidence on the association between AN, restrictive eating behaviour and food consumption. Studies with children and adolescents of both sexes of all races and ethnicities were included. Experimental and observational studies, systematic reviews, meta-analysis, case reports or series, conference abstracts, dissertations and theses were also included. The search was conducted in ten electronic databases and grey literature without language restriction on 14 November 2020. Twenty-four studies met the inclusion criteria. Most studies included girls and identified lower intake of energy content, fat and certain micronutrients. There was also a higher intake of caffeine, fibre, vegetables, legumes and fruits and a lower intake of low-quality snack, fast food, sweets and foods with high carbohydrate and fat contents. The need to improve the quality of the diet among study participants was also identified. Thus, it is recommended that the evaluation of food consumption be careful to develop effective prevention strategies for the development of AN/REB and minimise nutritional deficiencies in these individuals.

Zinc supplementation combined with antidepressant drugs for treatment of patients with depression: a systematic review and meta-analysis.

CONTEXT: Zinc is an essential trace mineral required for the function of brain and neural structures. The role of zinc supplementation in the prevention and treatment of depression has been suggested in clinical studies that reported a reduction in depressive symptoms. OBJECTIVE: The aim of this review was to determine whether zinc supplementation vs placebo can prevent or improve depressive symptoms in children, adolescents, or adults. DATA SOURCES: Five electronic databases were searched, and studies published until September 2019 were included without language restriction. STUDY SELECTION: Randomized, controlled, crossover trials that evaluated the effect of zinc supplementation vs a comparator for prevention or improvement of depressive symptoms in children, adolescents, or adults were eligible for inclusion. DATA EXTRACTION: Two authors independently performed data extraction and risk-of-bias assessment. RESULTS: The initial search identified 12 322 studies, 5 of which were eligible for meta-analysis. The standardized mean difference (SMD) showed an average reduction of 0.36 point (95%CI, -0.67 to -0.04) in the intervention group compared with the placebo group. Forstudies in which the mean age of participants was ≥ 40 years, the SMD was reduced by 0.61 point (95%CI, -1.12 to -0.09) in the intervention group vs the placebo group. The meta-analysis by sample size (< 60 individuals and ≥ 60 individuals) did not show an effect of zinc supplementation in reducing depressive symptoms (SMD -0.28; 95%CI, -0.67 to -0.10; and SMD -0.52; 95%CI, -1.10 to 0.06). CONCLUSION: Zinc supplementation may reduce depressive symptoms in individuals treated with antidepressant drugs for clinical depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42018081691.

Adiposidade Corporal e Apolipoproteínas em Crianças e Adolescentes: Metanálise de Estudos Prospectivos / Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies

Resumo Fundamento Excesso de adiposidade corporal e doenças cardiovasculares são problemas mundiais com crescente prevalência em crianças e adolescentes, sendo necessário investigar a relação destes, afim de construir estratégias de enfrentamento. Objetivo Investigar influência do excesso de adiposidade corporal sobre os níveis séricos de apolipoproteínas B e A1 (ApoB e ApoA1) em crianças e adolescentes. Métodos Busca sistemática nas bases de dados Medline/PubMed, Embase, Lilacs, Web of Science, Ovid e Science Direct de coortes consideradas elegíveis, avaliando-se qualidade metodológica e risco de viés; estudos combináveis, com boa qualidade e baixo risco de viés foram analisados com metanálise; a medida sumária utilizada foi a diferença de média ponderada e seu respectivo intervalo de confiança a 95%. Resultados 8 artigos preencheram os critérios de elegibilidade, incluindo indivíduos com média de idade variando de 9 a 15,7 anos. Para a metanálise, incluíram-se 4 artigos, com total de 7.974 crianças e adolescentes. Observou-se aumento médio de 4,94 mg/dL (IC 95%: 4,22 a 5,67 mg/dL) nos níveis de ApoB naqueles com excesso de adiposidade. Para a ApoA1, identificou-se redução média de -8,13 mg/dL (IC 95%: - 9,09 a -7,17 mg/dL) nos níveis séricos desse marcador em indivíduos com maior adiposidade corporal. Além disso, a influência do excesso de adiposidade corporal sobre os níveis de ApoA1 e ApoB foi maior entre adolescentes do que entre crianças. Conclusões O excesso de adiposidade corporal influenciou tanto na redução dos valores de ApoA1 quanto no aumento dos níveis de ApoB em crianças e adolescentes, e tais alterações foram mais relevantes entre adolescentes.(Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Excess Weight and Cardiovascular Diseases are health problems with increasing prevalence among children and adolescents, hence the need to investigate the issues related to them to better deal with the problem. Objective To investigate the influence of excess adiposity on the levels of apolipoprotein B and A1 in children and adolescents. Methods A systematic search was conducted in the PubMed, Embase, Lilacs, Web of Science, Ovid and Science direct databases, searching for cohort eligible studies and evaluating their results, methodological quality and risk of bias; combinable studies with good quality and low risk of bias were evaluated by meta-analysis. The summary measure used was the weighted mean difference (WMD) with its respective 95% confidence interval. Results 8 articles attended the eligibility criteria including individuals with age mean varying from 9 to 15.7 years of age. The meta-analysis included 4 articles with a total of 7,974 children and adolescents. It was observed a mean increase of 4,94mg/dL (95%CI: 4,22 to 5,67) in the ApoB levels in individuals with excess of body adiposity. For the ApoA1, we identified a mean reduction of -8,13mg/dL (95%CI: -9,09 to -7,17 mg/dL) in its levels in children and adolescents with higher body adiposity. Beside this, the influence of excess adiposity on the ApoB and ApoA1 levels was higher between adolescents than children. Conclusions The excess of body adiposity influenced both the reduction of ApoA1 values and the increase of ApoB levels, being these changes more relevant among adolescents. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies. / Adiposidade Corporal e Apolipoproteínas em Crianças e Adolescentes: Metanálise de Estudos Prospectivos.

BACKGROUND: Excess Weight and Cardiovascular Diseases are health problems with increasing prevalence among children and adolescents, hence the need to investigate the issues related to them to better deal with the problem. OBJECTIVE: To investigate the influence of excess adiposity on the levels of apolipoprotein B and A1 in children and adolescents. METHODS: A systematic search was conducted in the PubMed, Embase, Lilacs, Web of Science, Ovid and Science direct databases, searching for cohort eligible studies and evaluating their results, methodological quality and risk of bias; combinable studies with good quality and low risk of bias were evaluated by meta-analysis. The summary measure used was the weighted mean difference (WMD) with its respective 95% confidence interval. RESULTS: 8 articles attended the eligibility criteria including individuals with age mean varying from 9 to 15.7 years of age. The meta-analysis included 4 articles with a total of 7,974 children and adolescents. It was observed a mean increase of 4,94mg/dL (95%CI: 4,22 to 5,67) in the ApoB levels in individuals with excess of body adiposity. For the ApoA1, we identified a mean reduction of -8,13mg/dL (95%CI: -9,09 to -7,17 mg/dL) in its levels in children and adolescents with higher body adiposity. Beside this, the influence of excess adiposity on the ApoB and ApoA1 levels was higher between adolescents than children. CONCLUSIONS: The excess of body adiposity influenced both the reduction of ApoA1 values and the increase of ApoB levels, being these changes more relevant among adolescents. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: Excesso de adiposidade corporal e doenças cardiovasculares são problemas mundiais com crescente prevalência em crianças e adolescentes, sendo necessário investigar a relação destes, afim de construir estratégias de enfrentamento. OBJETIVO: Investigar influência do excesso de adiposidade corporal sobre os níveis séricos de apolipoproteínas B e A1 (ApoB e ApoA1) em crianças e adolescentes. MÉTODOS: Busca sistemática nas bases de dados Medline/PubMed, Embase, Lilacs, Web of Science, Ovid e Science Direct de coortes consideradas elegíveis, avaliando-se qualidade metodológica e risco de viés; estudos combináveis, com boa qualidade e baixo risco de viés foram analisados com metanálise; a medida sumária utilizada foi a diferença de média ponderada e seu respectivo intervalo de confiança a 95%. RESULTADOS: 8 artigos preencheram os critérios de elegibilidade, incluindo indivíduos com média de idade variando de 9 a 15,7 anos. Para a metanálise, incluíram-se 4 artigos, com total de 7.974 crianças e adolescentes. Observou-se aumento médio de 4,94 mg/dL (IC 95%: 4,22 a 5,67 mg/dL) nos níveis de ApoB naqueles com excesso de adiposidade. Para a ApoA1, identificou-se redução média de -8,13 mg/dL (IC 95%: - 9,09 a -7,17 mg/dL) nos níveis séricos desse marcador em indivíduos com maior adiposidade corporal. Além disso, a influência do excesso de adiposidade corporal sobre os níveis de ApoA1 e ApoB foi maior entre adolescentes do que entre crianças. CONCLUSÕES: O excesso de adiposidade corporal influenciou tanto na redução dos valores de ApoA1 quanto no aumento dos níveis de ApoB em crianças e adolescentes, e tais alterações foram mais relevantes entre adolescentes.(Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Effect of silymarin on biochemical indicators in patients with liver disease: Systematic review with meta-analysis.

AIM: To evaluate the effect of silymarin on the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (γGT) in patients with liver diseases. METHODS: A systematic review with meta-analysis of ramdomized and controlled clinical trials was performed, evaluating the effects of sylimarin in patients with hepatic diseases, published by January 31, 2016. Clinical trials were sought on the basis of The Cochrane Central Register of Controlled Trials in the Cochrane Library, PubMed/Medline, Scopus, Web of Science, Lilacs and Clinical Trials. The trials with adult and elderly patients of both sexes, with Liver Diseases who took oral silymarin supplementation, as extract or isolated, as well as Silymarin combined with other nutrients, were included. The trials should provide information about the intervention, such as dosages and detailing of the product used, besides the mean and standard deviation of serum levels of ALT, AST and γGT of the baseline and at the end of the intervention. RESULTS: An amount of 10904 publications were identified. From those, only 17 were included in the systematic review and 6 in the meta-analysis, according to the used selection criteria. In this meta-analysis, the results indicated a reduction of 0.26 IU/mL (95%CI: -0.46-0.07, P = 0.007) at the level of ALT and 0.53 IU/mL (95%CI: -0.74-0.32, P = 0.000) at the serum levels of AST after using the silymarin, both, statistically significant, but with no clinical relevance. There was no significant change in the γGT levels. Subgroup analyzes were also performed for the biochemical markers in relation to the type of intervention, whether silymarin isolated or associated with other nutrients and the time of intervention (whether ≥ 6 mo or < 6 mo). Significant differences were not found. The evaluated studies presented a high degree of heterogeneity and low methodological quality in the carried out analysis. CONCLUSION: Silymarin minimally reduced, but without clinical relevance, the serum levels of ALT and AST. It is necessary to carry out studies with more appropriate methodological designs.

Hypertriglyceridemic Waist Phenotype and Changes in the Fasting Glycemia and Blood Pressure in Children and Adolescents Over One-Year Follow-Up Period / Fenótipo Cintura Hipertrigliceridêmica e mudanças na glicemia de jejum e pressão arterial de crianças e adolescentes após um ano de seguimento

Abstract Background: The hypertriglyceridemic waist (HTW) phenotype is defined as the simultaneous presence of increased waist circumference (WC) and serum triglycerides (TG) levels and it has been associated with cardiometabolic risk in children and adolescents. Objective: The objective was to evaluate the influence of HTW phenotype in the fasting glycemia and blood pressure in children and adolescents over one-year follow-up period. Methods: It is a cohort study involving 492 children and adolescents from 7 to 15 years old, both genders, who were submitted to anthropometric, biochemical and clinical evaluation at the baseline, and also after 6 and 12 months of follow-up. Generalized Estimating Equation (GEE) models were calculated to evaluate the longitudinal influence of the HTW phenotype in the glycemia and blood pressure over one-year. Results: It was observed a prevalence of 10.6% (n = 52) of HTW phenotype in the students. The GEE models identified that students with HTW phenotype had an increase of 3.87 mg/dl in the fasting glycemia mean (CI: 1.68-6.05) and of 3.67mmHg in the systolic blood pressure (SBP) mean (CI: 1.55-6.08) over one-year follow-up, after adjusting for confounding variables. Conclusions: The results of this study suggest that HTW phenotype is a risk factor for longitudinal changes in glycemia and SBP in children and adolescents over one-year follow-up period.

Resumo Fundamento: O fenótipo de cintura hipertrigliceridêmica (CHT) é definido como a presença simultânea de circunferência de cintura (CC) e níveis séricos de triglicérides (TG) aumentados e tem sido associado com risco cardiometabólico em crianças e adolescentes. Objetivo: Avaliar a influência do fenótipo CHT na glicemia de jejum e na pressão arterial em crianças e adolescentes em um período de acompanhamento de um ano. Métodos: Trata-se de um estudo de coorte envolvendo 492 crianças e adolescentes de 7 a 15 anos de ambos os sexos, que foram submetidos à avaliação antropométrica, bioquímica e clínica no início e também após 6 e 12 meses de seguimento. Os modelos de Equação de Estimulação Generalizada (GEE) foram calculados para avaliar a influência longitudinal do fenótipo CHT na glicemia e na pressão arterial ao longo de um ano. Resultados: Foi observada uma prevalência de 10,6% (n = 52) do fenótipo CHT nos estudantes. Os modelos GEE identificaram que os estudantes com fenótipo CHT apresentaram aumento de 3,87 mg/dl na média de glicemia em jejum (IC: 1,68-6,05) e de 3,67 mmHg na pressão arterial sistólica media (PAS) (IC: 1,55-6,08) depois de um ano de acompanhamento, após ajuste para variáveis de confusão. Conclusões: Os resultados deste estudo sugerem que o fenótipo CHT é um fator de risco para alterações longitudinais da glicemia e da PAS em crianças e adolescentes em um período de um ano de seguimento.

Hypertriglyceridemic Waist Phenotype and Changes in the Fasting Glycemia and Blood Pressure in Children and Adolescents Over One-Year Follow-Up Period.

BACKGROUND:: The hypertriglyceridemic waist (HTW) phenotype is defined as the simultaneous presence of increased waist circumference (WC) and serum triglycerides (TG) levels and it has been associated with cardiometabolic risk in children and adolescents. OBJECTIVE:: The objective was to evaluate the influence of HTW phenotype in the fasting glycemia and blood pressure in children and adolescents over one-year follow-up period. METHODS:: It is a cohort study involving 492 children and adolescents from 7 to 15 years old, both genders, who were submitted to anthropometric, biochemical and clinical evaluation at the baseline, and also after 6 and 12 months of follow-up. Generalized Estimating Equation (GEE) models were calculated to evaluate the longitudinal influence of the HTW phenotype in the glycemia and blood pressure over one-year. RESULTS:: It was observed a prevalence of 10.6% (n = 52) of HTW phenotype in the students. The GEE models identified that students with HTW phenotype had an increase of 3.87 mg/dl in the fasting glycemia mean (CI: 1.68-6.05) and of 3.67mmHg in the systolic blood pressure (SBP) mean (CI: 1.55-6.08) over one-year follow-up, after adjusting for confounding variables. CONCLUSIONS:: The results of this study suggest that HTW phenotype is a risk factor for longitudinal changes in glycemia and SBP in children and adolescents over one-year follow-up period. FUNDAMENTO:: O fenótipo de cintura hipertrigliceridêmica (CHT) é definido como a presença simultânea de circunferência de cintura (CC) e níveis séricos de triglicérides (TG) aumentados e tem sido associado com risco cardiometabólico em crianças e adolescentes. OBJETIVO:: Avaliar a influência do fenótipo CHT na glicemia de jejum e na pressão arterial em crianças e adolescentes em um período de acompanhamento de um ano. MÉTODOS:: Trata-se de um estudo de coorte envolvendo 492 crianças e adolescentes de 7 a 15 anos de ambos os sexos, que foram submetidos à avaliação antropométrica, bioquímica e clínica no início e também após 6 e 12 meses de seguimento. Os modelos de Equação de Estimulação Generalizada (GEE) foram calculados para avaliar a influência longitudinal do fenótipo CHT na glicemia e na pressão arterial ao longo de um ano. RESULTADOS:: Foi observada uma prevalência de 10,6% (n = 52) do fenótipo CHT nos estudantes. Os modelos GEE identificaram que os estudantes com fenótipo CHT apresentaram aumento de 3,87 mg/dl na média de glicemia em jejum (IC: 1,68-6,05) e de 3,67 mmHg na pressão arterial sistólica media (PAS) (IC: 1,55-6,08) depois de um ano de acompanhamento, após ajuste para variáveis de confusão. CONCLUSÕES:: Os resultados deste estudo sugerem que o fenótipo CHT é um fator de risco para alterações longitudinais da glicemia e da PAS em crianças e adolescentes em um período de um ano de seguimento.