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1.
BMC Health Serv Res ; 24(1): 410, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38566059

RESUMO

BACKGROUND: The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated. METHODS: From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them. RESULTS: From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps. CONCLUSIONS: mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.


Assuntos
Aplicativos Móveis , Médicos de Atenção Primária , Telemedicina , Humanos , Estudos Transversais , Israel , Reprodutibilidade dos Testes , Distribuição Aleatória , População do Oriente Médio
2.
BMC Prim Care ; 23(1): 340, 2022 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-36575392

RESUMO

BACKGROUND: Behavioral treatments can augment the success of pharmacotherapy in smoking cessation. The aim of this study was to compare smoking quit rates between patients receiving individual counseling with their general practitioner during office visits or intensive counselling with behavioral support, both augmented by varenicline. METHODS: A nationwide retrospective cohort study conducted in a large Healthcare Maintenance Organization in Israel. We selected randomly patients who filled a prescription for varenicline and received either individual consulting by their general practitioner or intensive counselling with behavioural support, and asked them to answer a questionnaire. The outcome variables were smoking cessation 26-52 weeks following the beginning of treatment and satisfaction with the process. RESULTS: 870 patients were contacted and 604 agreed to participate (a response rate of 69%); 301 patients in the general practitioner group, 300 in the intensive counselling group and 3 were excluded due to missing date. The quit rate was 36.5% in the general practitioner group and 42.3% in the intensive counselling group (P = 0.147). In a logistic regression analysis, controlling for age, gender, socioeconomic status, ischemic heart disease, chronic obstructive pulmonary disease, pack years and duration of varenicline consumption, the adjusted OR for quitting in the general practitioner group was 0.79 (95% CI 0.56,1.13). The adjusted OR was higher in the group with the highest socioeconomic status at 2.06 (1.39,3.07) and a longer period of varenicline consumption at 1.30 (1.15,1.47). Age, gender and cigarette pack-years were not associated with quit rate. In the general practitioner group 68% were satisfied with the process, while 19% were not. In the intensive counselling group 64% were satisfied and 14% were not (P = 0.007). CONCLUSION: We did not detect a statistically significant difference in smoking quit rates, though there was a trend towards higher quit rates with intensive counselling.


Assuntos
Clínicos Gerais , Humanos , Vareniclina/uso terapêutico , Estudos Retrospectivos , Fumar/tratamento farmacológico , Aconselhamento
3.
Eur J Gen Pract ; 28(1): 142-149, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35695024

RESUMO

BACKGROUND: Acute upper respiratory infections are the most common reason for primary physician visits in the community. This study investigated whether the type of antibiotic used to treat streptococcal tonsillitis can reduce the burden by affecting the number of additional visits. OBJECTIVES: To assess the effect of different antibiotic treatments for tonsillitis on the number of additional primary physician visits and the development of infectious or inflammatory sequels. METHODS: This retrospective study included first cases of culture-confirmed streptococcal tonsillitis (n = 242,366, 55.3% females, 57.6% aged 3-15 years) treated in primary clinics throughout Israel between the years 2010 and 2019. Primary outcomes were the number of additional primary physician visits, due to any cause or due to specific upper airway infections. Secondary outcomes were the number of developed complications, such as peritonsillar abscess, post-streptococcal glomerulonephritis, rheumatic fever, post-streptococcal arthritis, chorea and death. RESULTS: Compared to penicillin-V, adjusted incidence rate ratios (IRR) for additional primary physician visits at 30-days were highest for IM benzathine-benzylpenicillin (IRR = 1.46, CI 1.33-1.60, p < .001) and cephalosporin treatment (IRR = 1.27, CI 1.24-1.30, p < .001). Similar results were noted for visits due to specific diagnoses such as recurrent tonsillitis, otitis media and unspecified upper respiratory tract infection. Amoxicillin showed decreased adjusted odds ratio (aOR) of developing complications (aOR = 0.68, CI 0.52-0.89, p < .01 for any complication. aOR = 0.75, CI 0.55-1.02, p = .07 for peritonsillar or retropharyngeal abscess). CONCLUSION: Penicillin-V treatment is associated with fewer additional primary physician visits compared to other antibiotic treatments. Amoxicillin and penicillin-V are associated with fewer complications. These findings are limited by the retrospective nature of the study and lack of adjustment for illness severity. Further prospective studies may be warranted to validate results.


Assuntos
Abscesso Peritonsilar , Faringite , Infecções Respiratórias , Tonsilite , Amoxicilina , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/tratamento farmacológico , Faringite/tratamento farmacológico , Estudos Prospectivos , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Tonsilite/tratamento farmacológico , Resultado do Tratamento
4.
J Hepatol ; 71(2): 379-388, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31075323

RESUMO

BACKGROUND & AIM: It is unclear if a reduction in hepatic fat content (HFC) is a major mediator of the cardiometabolic benefit of lifestyle intervention, and whether it has prognostic significance beyond the loss of visceral adipose tissue (VAT). In the present sub-study, we hypothesized that HFC loss in response to dietary interventions induces specific beneficial effects independently of VAT changes. METHODS: In an 18-month weight-loss trial, 278 participants with abdominal obesity/dyslipidemia were randomized to low-fat (LF) or Mediterranean/low-carbohydrate (MED/LC + 28 g walnuts/day) diets with/without moderate physical activity. HFC and abdominal fat-depots were measured using magnetic resonance imaging at baseline, after 6 (sub-study, n = 158) and 18 months. RESULTS: Of 278 participants (mean HFC 10.2% [range: 0.01%-50.4%]), the retention rate was 86.3%. The %HFC substantially decreased after 6 months (-6.6% absolute units [-41% relatively]) and 18 months (-4.0% absolute units [-29% relatively]; p <0.001 vs. baseline). Reductions of HFC were associated with decreases in VAT beyond weight loss. After controlling for VAT loss, decreased %HFC remained independently associated with reductions in serum gamma glutamyltransferase and alanine aminotransferase, circulating chemerin, and glycated hemoglobin (p <0.05). While the reduction in HFC was similar between physical activity groups, MED/LC induced a greater %HFC decrease (p = 0.036) and greater improvements in cardiometabolic risk parameters (p <0.05) than the LF diet, even after controlling for VAT changes. Yet, the greater improvements in cardiometabolic risk parameters induced by MED/LC were all markedly attenuated when controlling for HFC changes. CONCLUSIONS: %HFC is substantially reduced by diet-induced moderate weight loss and is more effectively reduced by the MED/LC diet than the LF diet, independently of VAT changes. The beneficial effects of the MED/LC diet on specific cardiometabolic parameters appear to be mediated more by decreases in %HFC than VAT loss. LAY SUMMARY: High hepatic fat content is associated with metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. In the CENTRAL 18-month intervention trial, a Mediterranean/low-carbohydrate diet induced a greater decrease in hepatic fat content than a low-fat diet, conferring beneficial health effects that were beyond the favorable effects of visceral fat loss. ClinicalTrials.gov Identifier: NCT01530724.


Assuntos
Dieta com Restrição de Gorduras , Dieta Mediterrânea , Dislipidemias/dietoterapia , Fígado Gorduroso/dietoterapia , Obesidade Abdominal/dietoterapia , Adulto , Estudos de Coortes , Dislipidemias/diagnóstico por imagem , Exercício Físico , Fígado Gorduroso/diagnóstico por imagem , Feminino , Humanos , Gordura Intra-Abdominal , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico por imagem , Resultado do Tratamento , Redução de Peso
5.
Clin Nutr ESPEN ; 24: 82-89, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29576369

RESUMO

BACKGROUND & AIMS: The ability to mobilize pancreatic-fat and the meaning of decreased fat in the pancreas remain controversial. We followed the dynamics of pancreatic-fat and its morphology during various long weight-loss induced lifestyle-interventions. METHODS: In isolated workplace with monitored/provided lunch, we randomly assigned healthy persons with abdominal obesity or dyslipidemia for one of two 18-month equal-caloric diets: low-fat (LF) or Mediterranean/low-carbohydrate (Med/LC, with provided 1oz walnuts/day), with or without added moderate exercise (supervised gym membership). We used magnetic-resonance-imaging to quantify pancreatic-fat and morphology. RESULTS: At baseline, 277 eligible participants (mean age = 48 years; 88% men; pancreatic-fat = 17.4 ± 5.1%) had higher pancreatic-fat in men (17.7 ± 4.9% vs 14.9 ± 5.5% in women; p = 0.004). Following 18-month intervention (adherence = 86.3%) and moderate weight-loss (mean = -3.0 ± 5.5 kg), pancreatic-fat decreased moderately but significantly (-0.26 ± 2.18% units; p = 0.049). Med/LC diet induced a greater decrease in pancreatic-fat compared to LF (p = 0.043), and the combination of Med/LC diet + exercise exhibited the highest reduction (-0.69% units) as compared to LF diet without exercise (+0.12%units; p = 0.027 between groups). In multivariate regression models, after further adjusted for visceral adipose-tissue (ΔVAT), pancreatic-fat loss associated with both decreases in pancreatic-morphology ratio (perimeter divided by area; beta = 0.361; p < 0.001) and superficial-subcutaneous adipose-tissue loss (beta = 0.242; p = 0.001), but not with changes in intrahepatic-fat (beta = -0.034; p = 0.638). Pancreatic-fat loss associated with increased intake of polyunsaturated-fat (beta = -0.137; p = 0.032), as with improved high-density lipoprotein-cholesterol (HDL; beta = -0.156; p = 0.023) and triglycerides/HDL ratio (beta = 0.162; p = 0.015), independently of ΔVAT, but not with glycemic-control parameters (e.g. HbA1c, HOMA-IR and HOMA-beta; p > 0.2 for all). CONCLUSIONS: Pancreatic-fat loss is mainly associated with improved lipid, rather than glycemic profiles. Med/LC diet, mostly with exercise, may benefit pancreatic-fat loss. Pancreatic-morphology could serve as a biomarker of pancreatic-fat state. (ClinicalTrials.gov identifier: NCT01530724).


Assuntos
Dislipidemias/prevenção & controle , Imageamento por Ressonância Magnética , Obesidade Abdominal/prevenção & controle , Saúde Ocupacional , Pâncreas/patologia , Pancreatopatias/patologia , Redução de Peso/fisiologia , Programas de Redução de Peso , Adulto , Dieta com Restrição de Gorduras , Dislipidemias/diagnóstico por imagem , Dislipidemias/fisiopatologia , Exercício Físico , Feminino , Inquéritos Epidemiológicos , Humanos , Israel/epidemiologia , Lipoproteínas HDL , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico por imagem , Obesidade Abdominal/fisiopatologia , Pâncreas/diagnóstico por imagem , Pancreatopatias/diagnóstico por imagem , Resultado do Tratamento , Triglicerídeos
6.
Clin Nutr ; 37(4): 1145-1153, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28501343

RESUMO

BACKGROUND & AIMS: Data regarding the role of kidney adiposity, its clinical implications, and its dynamics during weight-loss are sparse. We investigated the effect of long-term weight-loss induced intervention diets on dynamics of renal-sinus-fat, an ectopic fat depot, and %renal-parenchymal-fat, lipid accumulation within the renal parenchyma. METHODS: We randomized 278 participants with abdominal obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets, with or without exercise. We quantified renal-sinus-fat and %renal-parenchymal-fat by whole body magnetic-resonance-imaging. RESULTS: Participants (age = 48 years; 89% men; body-mass-index = 31 kg/m2) had 86% retention to the trial after 18 months. Both increased renal-sinus-fat and %renal-parenchymal-fat were directly associated with hypertension, and with higher abdominal deep-subcutaneous-adipose-tissue and visceral-adipose-tissue (p of trend < 0.05 for all) after adjustment for body weight. Higher renal-sinus-fat was associated with lower estimated-glomerular-filtration-rate and with higher microalbuminuria and %HbA1C beyond body weight. After 18 months of intervention, overall renal-sinus-fat (-9%; p < 0.05 vs. baseline) but not %renal-parenchymal-fat (-1.7%; p = 0.13 vs. baseline) significantly decreased, and similarly across the intervention groups. Renal-sinus-fat and %renal-parenchymal-fat changes were correlated with weight-loss per-se (p < 0.05). In a model adjusted for age, sex, and visceral-adipose-tissue changes, 18 months reduction in renal-sinus-fat associated with decreased pancreatic, hepatic and cardiac fats (p < 0.05 for all) and with decreased cholesterol/high-density lipoprotein-cholesterol (HDL-c) (ß = 0.13; p = 0.05), triglycerides/HDL-c (ß = 0.13; p = 0.05), insulin (ß = 0.12; p = 0.05) and gamma glutamyl transpeptidase (ß = 0.24; p = 0.001), but not with improved renal function parameters or blood pressure. Decreased intake of sodium was associated with a reduction in %renal-parenchymal-fat, after adjustment for 18 months weight-loss (ß = 0.15; p = 0.026) and hypertension (ß = 0.14; p = 0.04). CONCLUSIONS: Renal-sinus-fat and renal-parenchymal-fat are fairly related to weight-loss. Decreased renal-sinus-fat is associated with improved hepatic parameters, independent of changes in weight or hepatic fat, rather than with improved renal function or blood pressure parameters. CLINICALTRIALS. GOVIDENTIFIER: NCT01530724.


Assuntos
Dislipidemias/dietoterapia , Gordura Intra-Abdominal , Rim , Obesidade/dietoterapia , Redução de Peso/fisiologia , Adulto , Dieta , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/patologia , Rim/diagnóstico por imagem , Rim/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
7.
Circulation ; 137(11): 1143-1157, 2018 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-29142011

RESUMO

BACKGROUND: We aimed to assess whether distinct lifestyle strategies can differentially affect specific body adipose depots. METHODS: We performed an 18-month randomized controlled trial among 278 sedentary adults with abdominal obesity (75%) or dyslipidemia in an isolated workplace with a monitored provided lunch. Participants were randomized to isocaloric low-fat or Mediterranean/low-carbohydrate (MED/LC) diet+28 g walnuts/day with/without added moderate physical activity (PA; 80% aerobic; supervised/free gym membership). Overall primary outcome was body fat redistribution, and the main specific end point was visceral adipose tissue (VAT). We further followed the dynamics of different fat depots (deep and superficial subcutaneous, liver, pericardial, muscle, pancreas, and renal sinus) by magnetic resonance imaging. RESULTS: Of 278 participants (age, 48 years, 89% men, body mass index, 30.8 kg/m2), 86% completed the trial with good adherence. The low-fat group preferentially decreased reported fat intake (-21.0% versus -11.5% for the MED/LC; P<0.001), and the MED/LC group decreased reported carbohydrates intake (-39.5% versus -21.3% for the low-fat group; P<0.001). The PA+ groups significantly increased the metabolic equivalents per week versus the PA- groups (19.0 versus 2.1; P=0.009). Whereas final moderate weight loss was indifferent, exercise attenuated the waist circumference rebound with the greatest effect in the MED/LCPA+ group (P<0.05). VAT (-22%), intrahepatic (-29%), and intrapericardial (-11%) fats declines were higher than pancreatic and femur intermuscular fats (1% to 2%) loss. Independent of weight loss, PA+ with either diet had a significantly greater effect on decreasing VAT (mean of difference, -6.67cm2; 95% confidence interval, -14.8 to -0.45) compared with PA-. The MED/LC diet was superior to the low-fat diet in decreasing intrahepatic, intrapericardial, and pancreatic fats (P<0.05 for all). In contrast, renal sinus and femoral intermuscular fats were not differentially altered by lifestyle interventions but by weight loss per se. In multivariate models further adjusted for weight loss, losing VAT or intrahepatic fat was independently associated with improved lipid profile, losing deep subcutaneous adipose tissue with improved insulin sensitivity, and losing superficial subcutaneous adipose tissue remained neutral except for an association with decreased leptin. CONCLUSIONS: Moderate weight loss alone inadequately reflects the significant lifestyle effects on atherogenic and diabetogenic fat depots. The MED/LC diet mobilizes specific ectopic fat depots, and exercise has an independent contribution to VAT loss. Fat depots exhibit diverse responsiveness and are differentially related to cardiometabolic markers. Distinct lifestyle protocols may uniquely induce fat mobilization from specific anatomic sites. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01530724.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Adiposidade , Dislipidemias/dietoterapia , Estilo de Vida Saudável , Lipídeos/sangue , Imageamento por Ressonância Magnética , Obesidade Abdominal/dietoterapia , Comportamento de Redução do Risco , Tecido Adiposo/metabolismo , Tecido Adiposo/fisiopatologia , Adulto , Idoso , Dieta com Restrição de Carboidratos , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Dislipidemias/sangue , Dislipidemias/diagnóstico por imagem , Dislipidemias/fisiopatologia , Exercício Físico , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Obesidade Abdominal/diagnóstico por imagem , Obesidade Abdominal/fisiopatologia , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
8.
Am J Clin Nutr ; 106(4): 984-995, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28814394

RESUMO

Background: In view of evidence linking pericardial fat accumulation with increased cardiovascular disease risk, strategies to reduce its burden are needed. Data comparing the effects of specific long-term dietary interventions on pericardial fat tissue mobilization are sparse.Objective: We sought to evaluate intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes during weight-loss interventions by different dietary regimens.Design: During 18 mo of a randomized controlled trial, we compared a Mediterranean/low-carbohydrate (MED/LC) diet plus 28 g walnuts/d with a calorically equal low-fat (LF) diet among randomly assigned participants with moderate abdominal obesity. We performed whole-body MRI and volumetrically quantified IPF and EPF among 80 participants to follow the 18-mo changes.Results: The participants [mean age: 48.6 y; mean body mass index (BMI; in kg/m2); 31.7; 90% men] had baseline IPF and EPF (mean ± SD) volumes of 172.4 ± 53.3 mL and 194.9 ± 71.5 mL, respectively. The 18-mo moderate weight loss of 3.7 kg was similar in both groups, but the reduction in waist circumference was higher in the MED/LC group (-6.9 ± 6.6 cm) than in the LF diet group (-2.3 ± 6.5 cm; P = 0.01). After 18 mo, the IPF volume had reduced twice as much in the MED/LC group compared with the LF group [-37 ± 26.2 mL (-22% ± 15%) compared with -15.5 ± 26.2 mL (-8% ± 15%), respectively; P < 0.05, after adjustment for changes in weight or visceral adipose tissue]. The EPF volume had reduced similarly in both groups [-41.6 ± 30.2 mL (-23% ± 16%) in the MED/LC group compared with -37.9 ± 28.3 mL (-19% ± 14%) in the LF group; P > 0.1]. After controlling for weight loss, IPF and EPF volume reduction paralleled changes in lipid profile but not with improved glycemic profile variables: the IPF relative reduction was associated with a decrease in triglycerides (TGs) (ß = 0.090; 95% CI: 0.026, 0.154; P = 0.007) and the ratio of TGs to high-density lipoprotein (HDL) cholesterol (ß = 2.689; 95% CI: 0.373, 5.003; P = 0.024), and the EPF relative reduction was associated with an increase in HDL cholesterol (ß = -0.452; 95% CI: -0.880, -0.023; P = 0.039) and a decrease in total cholesterol and HDL cholesterol (ß = 3.766; 95% CI: 1.092, 6.440; P = 0.007).Conclusions: Moderate but persistent dietary-induced weight loss substantially decreased both IPF and EPF volumes. Reduction of pericardial adipose tissues is independently associated with an improved lipid profile. The Mediterranean diet, rich in unsaturated fats and restricted carbohydrates, is superior to an LF diet in terms of the IPF burden reduction. This trial was registered at clinicaltrials.gov as NCT01530724.


Assuntos
Tecido Adiposo/metabolismo , Dieta Redutora/métodos , Carboidratos da Dieta/farmacologia , Gorduras na Dieta/farmacologia , Obesidade/dietoterapia , Pericárdio/metabolismo , Redução de Peso/fisiologia , Adiposidade , Adulto , Índice de Massa Corporal , Dieta com Restrição de Carboidratos , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Carboidratos da Dieta/administração & dosagem , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/metabolismo , Feminino , Humanos , Gordura Intra-Abdominal , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Nozes , Obesidade/sangue , Obesidade Abdominal/sangue , Obesidade Abdominal/dietoterapia , Circunferência da Cintura
9.
Pregnancy Hypertens ; 8: 46-50, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28501279

RESUMO

OBJECTIVE: To examine the recovery from severe Preeclampsia toxemia (PET) in women treated with magnesium sulfate (MgSO4) during the first 24h postpartum as reflected by the changes in various clinical and laboratory markers. STUDY DESIGN: The study population included all women diagnosed with severe PET that gave birth at the Soroka University Medical center between 2013 and 2014, and were treated with MgSO4 in the first 24h postpartum. Data were collected from the institutional computerized records. The different parameters were examined in 6h intervals and were compared using appropriate statistical tests. MAIN OUTCOMES MEASURES: Change in various postpartum laboratory and clinical parameters. RESULTS: During the study period there were 132 singleton deliveries with severe PET treated with a 24-hours postpartum MgSO4 regimen. Most of the women were primigravida and delivered vaginally. Both mean systolic and mean diastolic blood pressure values have shown recovery to normal values after the first 6h of treatment (P<0.001). Urine output and proteinuria have demonstrated later recovery (after 12h). CONCLUSIONS: When assessing the natural recovery of severe PET features, the earliest parameter to recover during the first 24h postpartum is hypertension followed by urine output and the proteinuria. Further larger studies are needed in order to confirm these results. Moreover, the use of these parameters may allow using shorter MgSO4 treatment regimens for appropriate women showing earlier recovery and facilitating quicker mother-baby bonding and emotional recovery.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Sulfato de Magnésio/administração & dosagem , Pré-Eclâmpsia/tratamento farmacológico , Adulto , Feminino , Humanos , Israel , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Proteinúria/tratamento farmacológico , Proteinúria/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Micção/efeitos dos fármacos , Urodinâmica/efeitos dos fármacos , Adulto Jovem
10.
J Appl Physiol (1985) ; 121(2): 518-27, 2016 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-27402560

RESUMO

It remains unclear whether intermuscular adipose tissue (IMAT) has any metabolic influence or whether it is merely a marker of abnormalities, as well as what are the effects of specific lifestyle strategies for weight loss on the dynamics of both IMAT and thigh muscle area (TMA). We followed the trajectory of IMAT and TMA during 18-mo lifestyle intervention among 278 sedentary participants with abdominal obesity, using magnetic resonance imaging. We measured the resting metabolic rate (RMR) by an indirect calorimeter. Among 273 eligible participants (47.8 ± 9.3 yr of age), the mean IMAT was 9.6 ± 4.6 cm(2) Baseline IMAT levels were directly correlated with waist circumference, abdominal subdepots, C-reactive protein, and leptin and inversely correlated with baseline TMA and creatinine (P < 0.05 for all). After 18 mo (86.3% adherence), both IMAT (-1.6%) and TMA (-3.3%) significantly decreased (P < 0.01 vs. baseline). The changes in both IMAT and TMA were similar across the lifestyle intervention groups and directly corresponded with moderate weight loss (P < 0.001). IMAT change did not remain independently associated with decreased abdominal subdepots or improved cardiometabolic parameters after adjustments for age, sex, and 18-mo weight loss. In similar models, 18-mo TMA loss remained associated with decreased RMR, decreased activity, and with increased fasting glucose levels and IMAT (P < 0.05 for all). Unlike other fat depots, IMAT may not represent a unique or specific adipose tissue, instead largely reflecting body weight change per se. Moderate weight loss induced a significant decrease in thigh muscle area, suggesting the importance of resistance training to accompany weight loss programs.


Assuntos
Gordura Abdominal/fisiopatologia , Músculo Esquelético/fisiopatologia , Obesidade Abdominal/fisiopatologia , Obesidade Abdominal/terapia , Obesidade/fisiopatologia , Obesidade/terapia , Redução de Peso , Gordura Abdominal/patologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Obesidade Abdominal/patologia , Tamanho do Órgão , Coxa da Perna/patologia , Coxa da Perna/fisiopatologia
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