Analysis of morbid obese women aerobic potential / Análisis del potencial aeróbico de obesas mórbidas

Abstract Introduction: nowadays, with the increase of world obesity and the numbers of morbidly obese people, a concerning public health problem that is difficult to solve rises up. Objective: to analyse the physiological responses after the 6-minute walk tests and maximum stress test in the arm cycle ergometer in morbidly obese pre-bariatric surgery women. Methods: fifteen level III obesity women aged 35.6 ± 6.6 years took part in this experiment. Firstly, they went through an anamnesis and body composition analysis; secondly, they were submitted to a 6-minute walk test and a maximum stress test in arm cycle ergometer on alternate days. Results: patients were able to perform the maximum stress test and showed better aerobic potentials in the arm cycle ergometer than in the 6-minute walk test. No significant differences were found between SPO2 and diastolic blood pressure between the moments of rest and after the tests, neither in the systolic blood pressure after the 6-minute walk test and the values of rest and post 5 minutes in the maximum stress test. The main differences found were between the maximum systolic blood pressure in the cycle ergometer test and the other moments and the heart rate after the tests and the heart rate at rest. Conclusion: the maximum stress test in arm cycle ergometer is a safe method that allows greater requirement and control applied to the heart system than in the 6-minute walk test. In addition, it allows the development of a more individualized aerobic training and prescription of aerobic physical exercise program.

Resumen Introducción: Actualmente, con el aumento de la obesidad en el mundo y del número de obesos mórbidos se evidencia un problema de salud pública de difícil resolución. Objetivo: analizar las respuestas fisiológicas tras las pruebas de caminata de 6 minutos y de esfuerzo máximo en cicloergómetro de brazos en obesas mórbidas precirugía bariátrica. Métodos: se evaluaron 15 mujeres con obesidad grado III con edad media de 35,6 ± 6,6 años, las cuales participaron inicialmente de una anamnesis con el análisis de la composición corporal y posteriormente participaron en días alternos de la prueba de 6 minutos de caminata y del mismo, prueba de esfuerzo máximo en cicloergómetro de brazos. Resultados: las pacientes lograron realizar la prueba de esfuerzo máximo y demostraron mejores potenciales aeróbicos en el cicloergómetro de brazos que en la prueba de caminata. No se encontraron diferencias significativas entre la SPO2 y la presión arterial diastólica entre los momentos de reposo y después de las pruebas y también en la presión arterial sistólica posterior a la prueba de caminata y los valores de reposo y después de 5 minutos en la prueba de esfuerzo máximo. Las principales diferencias se observaron entre la presión arterial sistólica máxima en la prueba en cicloergómetro y los otros momentos y en la frecuencia cardiaca después de las pruebas y las frecuencias cardiacas en reposo. Conclusión: la prueba de esfuerzo máximo en cicloergómetro de brazos es un método seguro que posibilita mayor exigencia y control aplicado al sistema cardíaco que en la prueba de caminata. Adicionalmente, permite un programa de entrenamiento y una prescripción del ejercicio físico aeróbico más individualizados.

Stromal-vascular fraction content and adipose stem cell behavior are altered in morbid obese and post bariatric surgery ex-obese women.

INTRODUCTION: Subcutaneous adipose tissue is an interesting source of autologous stem cells with a fundamental role in the pathophysiology of obesity, metabolic syndromes and insulin resistance. We hypothesize that obesity could alter the stromal-vascular fraction (SVF) and adipose stem cell (ASCs) functions, which could compromise its regenerative behavior. Furthermore, we aimed to evaluate whether ASCs derived from post bariatric surgery ex-obese women maintain their functions in a similar fashion as do those from individuals who have never been obese. METHODS: The SVF of subcutaneous adipose tissue from control (n = 6, body mass index - BMI - 27.5 ± 0.5 kg/m(2)), obese (n = 12, BMI 46.2 ± 5.1 kg/m(2)) and post bariatric surgery ex-obese (n = 7, initial BMI 47.8 ± 1.3 kg/m(2); final BMI 28.1 ± 1.1 kg/m(2)) women were isolated and evaluated by flow cytometry. ASCs were tested for lipid accumulation by perilipin, adipose differentiation-related protein (ADRP) and Oil Red O staining after adipogenic stimulus. The cytokines secreted by the ASCs and after lipid accumulation induction were also evaluated. RESULTS: The subcutaneous adipose tissue of obese and post bariatric surgery ex-obese women was enriched in pericytes (p = 0.0345). The number of supra-adventitial cells was not altered in the obese patients, but it was highly enriched in the post bariatric surgery ex-obese women (p = 0.0099). The ASCs of the post bariatric surgery ex-obese patients secreted more MCP-1 (monocyte chemoattractant protein-1; p = 0.0078). After lipid accumulation induction, the ASCs of the patients in all groups secreted less IL-6 than the ASCs with no adipogenic stimulus (p < 0.0001). Obese ASCs with lipid accumulation secreted the highest amount of IL-6 (p < 0.001) whereas the ASCs from the controls secreted the highest amount of adiponectin (p < 0.0001). The ASCs from the post bariatric surgery ex-obese patients showed the highest levels of lipid accumulation whereas those from the obese women had the lowest levels (p < 0.0001). CONCLUSIONS: SVF content and ASC behavior are altered in the subcutaneous adipose tissue of morbid obese women; these changes are not completely restored after bariatric surgery-induced weight loss. The cellular alterations described in this study could affect the regenerative effects of adipose stem cells. Further investigations are required to avoid jeopardizing the development of autologous stem cell-based therapies.

Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil.

BACKGROUND: To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. METHODS: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. RESULTS: Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies', (OR 1.57 [1.02-2.41]) were related to greater patients' adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients' adherence (p < 0.01). CONCLUSIONS: Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

Obesidade na adolescência: fator de risco para complicaçöes clínico-metabólicas / Obesity in adolescent: risk factor for metabolic clinical complications

Sessenta e seis adolescentes, sendo 38 obesos (25F/13M) e 28 näo obesos (23F/5M), pareados pelo sexo, idade, cor, nível de escolaridade e estágio de maturaçäo sexual, foram submetidos a um inquérito clínico-demográfico e à avaliaçäo clínico- laboratorial. A relaçäo cintura-quadril foi maior no grupo dos obesos do que nos näo obesos (0,86 +/- 0,08) vs. 0,74 +/- 0,04; p<0,01), assim como as medidas de pressäo arterial sistólica e diastólica (120,2 +/- 12, 1 vs. 105,4 +/- 9,1mmHg; p<0,01 e 743 +/- 7,7 vs. 65,5 +/- 9,4mmHg; p<0,01, respectivamente) Alesäo dermatológica acanthosis nigricans predominou no grupo dos obesos (n=24, 63,2 por cento). Os obesos apresentaram valores de HDL-colesterol inferiores aos dos nao obesos (36, 5 +/- 10,5 vs. 43, 9 +/- 9,2mg/dl, respectivamente; p<0,05). Os níveis de triglicerídeos e ácido úrico foram maiores no grupo dos obesos se comparado aos näo obesos (124,6 +/- 80,0 vs. 74,2 +/- 31,4mg/dl, respectivamente ; p<0,01 e 5,8 +/- 1,4 vs. 4,5 +/- 1,0mg/dl, respectivamente; p<0,01). Nao houve diferença nos valores de colesterol, LDL colesterol e na glicemia basal entre os dois grupos. Os adolescentes obesos procuraram tratamento na maioria das vezes movidos por uma preocupaçäo com a saúde (n=15, 39,5 por cento). Um número significativo desses adolescentes já havia feito uso de medicamentos visando a perda ponderal no passado. Conclímos que a abosidade na adolescência pode estar relacionada a um perfil clínico-metabólico desfavorável, caracterizado por níveis mais elevados de pressäo arterial sistólica e diastólica, triglicérideos, ácido úrico, e mais reduzidos de HDL-colestrol; e ainda pela presença de acanthosis nigricans.