Integrated control strategies for dengue, Zika, and Chikungunya virus infections.

Arboviruses are a major threat to public health in tropical regions, encompassing over 534 distinct species, with 134 capable of causing diseases in humans. These viruses are transmitted through arthropod vectors that cause symptoms such as fever, headache, joint pains, and rash, in addition to more serious cases that can lead to death. Among the arboviruses, dengue virus stands out as the most prevalent, annually affecting approximately 16.2 million individuals solely in the Americas. Furthermore, the re-emergence of the Zika virus and the recurrent outbreaks of chikungunya in Africa, Asia, Europe, and the Americas, with one million cases reported annually, underscore the urgency of addressing this public health challenge. In this manuscript we discuss the epidemiology, viral structure, pathogenicity and integrated control strategies to combat arboviruses, and the most used tools, such as vaccines, monoclonal antibodies, treatment, etc., in addition to presenting future perspectives for the control of arboviruses. Currently, specific medications for treating arbovirus infections are lacking, and symptom management remains the primary approach. However, promising advancements have been made in certain treatments, such as Chloroquine, Niclosamide, and Isatin derivatives, which have demonstrated notable antiviral properties against these arboviruses in vitro and in vivo experiments. Additionally, various strategies within vector control approaches have shown significant promise in reducing arbovirus transmission rates. These encompass public education initiatives, targeted insecticide applications, and innovative approaches like manipulating mosquito bacterial symbionts, such as Wolbachia. In conclusion, combatting the global threat of arbovirus diseases needs a comprehensive approach integrating antiviral research, vaccination, and vector control. The continued efforts of research communities, alongside collaborative partnerships with public health authorities, are imperative to effectively address and mitigate the impact of these arboviral infections on public health worldwide.

Cross-sectional analysis of students and school workers reveals a high number of asymptomatic SARS-CoV-2 infections during school reopening in Brazilian cities.

Brazil experienced one of the most prolonged periods of school closures, and reopening could have exposed students to high rates of SARS-CoV-2 infection. However, the infection status of students and school workers at the time of the reopening of schools located in Brazilian cities is unknown. Here we evaluated viral carriage by RT-PCR and seroprevalence of anti-SARS-CoV-2 antibodies (IgM and IgG) by immunochromatography in 2259 individuals (1139 students and 1120 school workers) from 28 schools in 28 Brazilian cities. We collected the samples within 30 days after public schools reopened and before the start of vaccination campaigns. Most students (n = 421) and school workers (n = 446) had active (qRT-PCR + IgM- IgG- or qRT-PCR + IgM + IgG-/+) SARS-CoV-2 infection. Regression analysis indicated a strong association between the infection status of students and school workers. Furthermore, while 45% (n = 515) of the students and 37% (n = 415) of the school workers were neither antigen nor antibody positive in laboratory tests, 16% of the participants (169 students and 193 school workers) were oligosymptomatic, including those reinfected. These individuals presented mild symptoms such as headache, sore throat, and cough. Notably, most of the individuals were asymptomatic (83.9%). These results indicate that many SARS-CoV-2 infections in Brazilian cities during school reopening were asymptomatic. Thus, our study highlights the need to promote a coordinated public health effort to guarantee a safe educational environment while avoiding exacerbating pre-existent social inequalities in Brazil, reducing social, mental, and economic losses for students, school workers, and their families.

Ultra-Processed Food Availability and Sociodemographic Associated Factors in a Brazilian Municipality.

The availability of ultra-processed foods in a municipality tends to be related to different types of food retailers and their location in the territory, besides social, economic, and demographic factors. The aim of this study was to evaluate the availability of ultra-processed foods according to different types of food retailers and sociodemographic factors. This is a cross-sectional observational study carried out with audit data from food retailers in the municipality of Jundiaí, SP. Using a validated instrument, data on the availability of 18 types of ultra-processed foods were used to create a score of ultra-processed foods, ranging from 0 to 100 points, and five subscores referring to the ultra-processed food subgroups. Descriptive statistics and means comparison tests were performed to verify differences in the ultra-processed food availability score, according to the food retail type, household income, number of household members, and percentage of people of the color population in the census tract in which food retailers were located. Geo-referenced maps were used to characterize the score of ultra-processed in the territory, according to sociodemographic variables. A total of 649 food retailers were analyzed, most of which were classified as neighborhood markets (25.4%). The supermarkets were the category with the highest ultra-processed food availability score. Among the subgroups of ultra-processed foods analyzed, candies, soft drinks, and snacks were available in 60% of the food retailers. Higher ultra-processed food availability score was observed in regions with lower income, higher percentage of people of color population, and higher number of members per household. The findings show that the greater availability of ultra-processed foods is related to supermarkets and markets and regions of greater social vulnerability, which can put this population at nutritional risk.

GeoSES: A socioeconomic index for health and social research in Brazil.

The individual's socioeconomic conditions are the most relevant to predict the quality of someone's health. However, such information is not usually found in medical records, making studies in the area difficult. Therefore, it is common to use composite indices that characterize a region socioeconomically, such as the Human Development Index (HDI). The main advantage of the HDI is its understanding and adoption on a global scale. However, its applicability is limited for health studies since its longevity dimension presents mathematical redundancy in regression models. Here we introduce the GeoSES, a composite index that summarizes the main dimensions of the Brazilian socioeconomic context for research purposes. We created the index from the 2010 Brazilian Census, whose variables selection was guided by theoretical references for health studies. The proposed index incorporates seven socioeconomic dimensions: education, mobility, poverty, wealth, income, segregation, and deprivation of resources and services. We developed the GeoSES using Principal Component Analysis and evaluated its construct, content, and applicability. GeoSES is defined at three scales: national (GeoSES-BR), Federative Unit (GeoSES-FU), and intra-municipal (GeoSES-IM). GeoSES-BR dimensions showed a good association with HDI-M (correlation above 0.85). The model with the poverty dimension best explained the relative risk of avoidable cause mortality in Brazil. In the intra-municipal scale, the model with GeoSES-IM was the one that best explained the relative risk of mortality from circulatory system diseases. By applying spatial regressions, we demonstrated that GeoSES shows significant explanatory potential in the studied scales, being a compelling complement for future researches in public health.

Epidemiological and geographical characterization of leprosy in a Brazilian hyperendemic municipality.

This study aimed to identify the distribution pattern of leprosy in a hyperendemic municipality in Brazil and determine its relationship with the clinico-epidemiological situation over 11 years. The geographic information system, MapInfo, spatial scan statistics and the Moran I index were used to analyze new cases. The digital cartographic base was used to map clusters of new paucibacillary and multibacillary cases and cases in minors under 15 years old. Socioeconomic indicators are shown using the choropleth mapping technique. A reduction in the detection coefficient, increases in high-risk spatial clusters, marked changes in the distribution of high-risk and low-risk clusters, and high-risk clusters of minors under 15 years old were observed from 2006 to 2010, showing recent illness, the presence of active foci, and overlapping of high-risk clusters of multibacillary infection in minors under 15 years old. Leprosy remains a public health problem in Rondonópolis, Mato Grosso State; the high-risk areas require an intensification of control measures and active search strategies to detect new cases.

Cycling for Transportation in Sao Paulo City: Associations with Bike Paths, Train and Subway Stations.

Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey (n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults' residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences (OR (Odds Ratio) = 2.54, 95% CI (Confidence interval) 1.16-5.54) and with the presence of train/subway stations for distances >500 m from residences (OR = 2.07, 95% CI 1.10-3.86). These results are important to support policies to improve cycling for transportation in megacities such as Sao Paulo.

Epidemiological and geographical characterization of leprosy in a Brazilian hyperendemic municipality / Caracterização epidemiológica e geográfica da hanseníase em um município brasileiro hiperendêmico / Caracterización epidemiológica y geográfica de lepra en un municipio brasileño hiperendémico

Abstract: This study aimed to identify the distribution pattern of leprosy in a hyperendemic municipality in Brazil and determine its relationship with the clinico-epidemiological situation over 11 years. The geographic information system, MapInfo, spatial scan statistics and the Moran I index were used to analyze new cases. The digital cartographic base was used to map clusters of new paucibacillary and multibacillary cases and cases in minors under 15 years old. Socioeconomic indicators are shown using the choropleth mapping technique. A reduction in the detection coefficient, increases in high-risk spatial clusters, marked changes in the distribution of high-risk and low-risk clusters, and high-risk clusters of minors under 15 years old were observed from 2006 to 2010, showing recent illness, the presence of active foci, and overlapping of high-risk clusters of multibacillary infection in minors under 15 years old. Leprosy remains a public health problem in Rondonópolis, Mato Grosso State; the high-risk areas require an intensification of control measures and active search strategies to detect new cases.

Resumo: O estudo teve como objetivos identificar o padrão de distribuição da hanseníase em um município brasileiro hiperendêmico e determinar a relação com o quadro clínico-epidemiológico ao longo de 11 anos. Os casos novos foram analisados com o sistema de informação geográfica, MapInfo, estatística scan espacial e índice Moran I. A base cartográfica digital foi usada para mapear os clusters de casos paucibacilares e multibacilares novos e casos em menores de 15 anos. Os indicadores socioeconômicos são mostrados através da técnica de mapeamento coroplético. Entre 2006 e 2010, foram observados uma redução no coeficiente de detecção, aumento no clusters espaciais de alto risco, mudanças marcantes na distribuição de clusters de alto e baixo risco e clusters de alto risco em menores de 15 anos, sugerindo doença recente, a presença de focos ativos e a sobreposição de clusters de alto risco para infecção multibacilar em menores de 15 anos. A hanseníase persiste enquanto problema de saúde pública em Rondonópolis, Mato Grosso; as áreas de alto risco exigem a intensificação de medidas de controle, além de estratégias de busca ativa para detectar casos novos.

Resumen: Este estudio tuvo como objetivo identificar la distribución de los patrones de lepra en una municipalidad hiperendémica en Brasil y determinar su relación con la situación clínico-epidemiológica durante 11 años. El sistema de información geográfica, MapInfo, estadísticas de escaneo espacial y el índice de Moran se usaron para analizar nuevos casos. La base cartográfica digital se usó para mapear clústeres de nuevos casos multibacilares y paucibacilares, así como casos en menores por debajo de 15 años de edad. Los indicadores socioeconómicos se presentan usando la técnica de mapeo de coropletas. La reducción en la detección del coeficiente, se incrementa en los clústeres de alto riesgo espaciales, asimismo, se observaron de 2006 a 2010 cambios considerables en la distribución de los clústeres de alto riesgo y bajo riesgo, así como en clústeres de alto riesgo con menores con menos de 15 años de edad, mostrando los casos de enfermedad reciente la presencia de focos activos, así como solapando clústeres de alto riesgo de infección multibacilar en menores por debajo de los 15 años de edad. La lepra continúa siendo un problema de salud pública en Rondonópolis, Mato Grosso; las áreas de alto riesgo necesitan una intensificación de las medidas de control y una búsqueda activa de estrategias, con el fin de detectar nuevos casos.

Public Open Spaces and Leisure-Time Walking in Brazilian Adults.

Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults' residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants' homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09-2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.

Polymorphisms in IL-10 and INF-γ genes are associated with early atherosclerosis in coronary but not in carotid arteries: A study of 122 autopsy cases of young adults.

Atherosclerosis is a complex disease, involving both genetic and environmental factors. However, the influence of genetic variations on its early development remains unclear. This study examined the association of 12 different polymorphisms with atherosclerosis severity in anterior descending coronary (DA, n = 103) and carotid arteries (CA, n = 66) of autopsied young adults (< 30 years old). Histological sections (H-E) were classified according to the American Heart Association. Polymorphisms in ACE, TNF-α (- 308G/A and - 238 G/A), IFN-γ (+ 874 A/T), MMP-9 (- 1562 C/T), IL-10 (- 1082 A/G and - 819 C/T), NOS3 (894 G/T), ApoA1 (rs964184), ApoE (E2E3E4 isoforms), and TGF-ß (codons 25 and 10) genes were genotyped by gel electrophoresis or automatic DNA sequencing. Firearm projectile or car accident was the main cause of death, and no information about classical risk factors was available. Histological analysis showed high prevalence of type III atherosclerotic lesions in both DA (69%) and CA (39%) arteries, while severe type IV and V lesions were observed in 14% (DA) and 33% (CA). Allele frequencies and genotype distributions were determined. Among the polymorphisms studied, IFN-γ and IL-10 (- 1082 A/G) were related to atherosclerosis severity in DA artery. No association between genotypes and lesion severity was found in CA. In conclusion, we observed that the high prevalence of early atherosclerosis in young adults is associated with IFN-γ (p < 0.001) and IL-10 (p = 0.013) genotypes. This association is blood vessel dependent. Our findings suggest that the vascular system presents site specialization, and specific genetic variations may provide future biomarkers for early disease identification.

Socio-economic and environmental effects influencing the development of leprosy in Bahia, north-eastern Brazil.

OBJECTIVES: To investigate spatial clusters and possible associations between relative risks of leprosy with socio-economic and environmental factors, taking into account diagnosed cases in children under 15 years old. METHODS: An ecological study was conceived using data aggregated by municipality to identify possible spatial clusters of leprosy from 2005 to 2011. Relative risks were calculated accounting for the respective covariate gender. The second stage of the analysis consisted of verifying possible associations between the relative risks of leprosy as a dependent variable, and socio-economic and environmental variables as independent. This was performed using a multivariate regression analysis according to a previously defined conceptual framework. RESULTS: Overall rates have decreased from 0.88/10 000 in 2005 to 0.52 in 2011. Spatial scan statistics identified 4 high-risk and 6 low-risk clusters. In the regression model, after allowing for spatial dependence, relative risks were associated with higher percentage of water bodies, higher Gini index, higher percentage of urban population, larger average number of dwellers by permanent residence and smaller percentage of residents born in Bahia. CONCLUSIONS: Although relative risks of leprosy in Bahia have been decreasing, they remain very high. The association between relative risks of leprosy and water bodies in the proposed geographic scale indicates that hypothesis linking M. leprae and humid environments cannot be discarded. Socio-economic conditions such as inequality, a greater number of dwellers by residence and migration are derived from the urbanisation process carried out in this State. Precarious settlements and poor living conditions in the cities would favour the continuity of leprosy transmission.

Cultivo de tambaqui em gaiolas de baixo volume: efeito da densidade de estocagem na produção de biomassa / Tambaqui farming in small volume cages: effects of stocking density on the biomass production

Fish farming in small floating cages is the subject of local discussions due to the possible sustainable use of the Amazon basin, alleviating poverty of people who live near lakes and rivers. Tambaqui is one of the main species indicated to this end because this is an omnivorous species, well accepted in the local market, whose demand grows fast due to the over-fishing around big western Amazon cities such as Manaus. However, more information about tambaqui farming in small volume cages is necessary to increase and advance production in this system. Therefore, we studied the effects of four stocking densities (10, 20, 30 and 40fish/m3) in tambaqui farming in small cages (1m3). We evaluated fish growth and number of gills parasites. The results showed clear fish biomass rise by the increase of tambaqui stocking density. No effect of stocking density was observed on fish individual growth, survival and number  of gills parasites.(AU)

A criação de peixes em gaiolas flutuantes na Amazônia Ocidental é um assunto de interesse inclusive governamental, pois traz à discussão a possibilidade do uso sustentável de grandes corpos de água da bacia amazônica, podendo, assim, beneficiar populações ribeirinhas com geração de trabalho e renda. O tambaqui é umas das espécies mais indicadas para esse fim por ser um peixe onívoro, bem apreciado no mercado consumidor local, além da demanda crescente, devido à redução dos estoques naturais pela pesca extrativista e desmatamento da mata ciliar nos arredores das grandes cidades nortistas como Manaus. Entretanto, mais informações básicas sobre a criação da espécie em gaiolas de baixo volume ainda são necessárias para o aperfeiçoamento e avanço da atividade. O presente trabalho estudou os efeitos de quatro densidades de estocagem (10, 20, 30 e 40 peixes/m3) no crescimento e na incidência de parasitas, monogêneas, nas brânquias do tambaqui cultivado em gaiolas de baixo volume (1m3). O estudo pode contribuir com mais informações elementares para a exploração racional dos recursos naturais amazônicos, o tambaqui e os grandes corpos de água. Os resultados mostram que é possível aumentar a produção de biomassa de tambaqui em gaiolas de baixo volume de 1m3 aumentando-se a densidade de estocagem até 40 peixes/m3,sem prejuízos no crescimento e aumento de carga parasitária nas brânquias dos peixes.(AU)

Cultivo de tambaqui em gaiolas de baixo volume: efeito da densidade de estocagem na produção de biomassa

Fish farming in small floating cages is the subject of local discussions due to the possible sustainable use of the Amazon basin, alleviating poverty of people who live near lakes and rivers. "Tambaqui" is one of the main species indicated to this end because this is an omnivorous species, well accepted in the local market, whose demand grows fast due to the over-fishing around big western Amazon cities such as Manaus. However, more information about "tambaqui" farming in small volume cages is necessary to increase and advance production in this system. Therefore, we studied the effects of four stocking densities (10, 20, 30 and 40fish/m³) in "tambaqui" farming in small cages (1m³). We evaluated fish growth and number of gills parasites. The results showed clear fish biomass rise by the increase of "tambaqui" stocking density. No effect of stocking density was observed on fish individual growth, survival and number of gills parasites.

A criação de peixes em gaiolas flutuantes na Amazônia Ocidental é um assunto de interesse inclusive governamental, pois traz à discussão a possibilidade do uso sustentável de grandes corpos de água da bacia amazônica, podendo, assim, beneficiar populações ribeirinhas com geração de trabalho e renda. O tambaqui é umas das espécies mais indicadas para esse fim por ser um peixe onívoro, bem apreciado no mercado consumidor local, além da demanda crescente, devido à redução dos estoques naturais pela pesca extrativista e desmatamento da mata ciliar nos arredores das grandes cidades nortistas como Manaus. Entretanto, mais informações básicas sobre a criação da espécie em gaiolas de baixo volume ainda são necessárias para o aperfeiçoamento e avanço da atividade. O presente trabalho estudou os efeitos de quatro densidades de estocagem (10, 20, 30 e 40 peixes/m³) no crescimento e na incidência de parasitas, monogêneas, nas brânquias do tambaqui cultivado em gaiolas de baixo volume (1m³). O estudo pode contribuir com mais informações elementares para a exploração racional dos recursos naturais amazônicos, o tambaqui e os grandes corpos de água. Os resultados mostram que é possível aumentar a produção de biomassa de tambaqui em gaiolas de baixo volume de 1m³ aumentando-se a densidade de estocagem até 40 peixes/m³, sem prejuízos no crescimento e aumento de carga parasitária nas brânquias dos peixes.

Cultivo de tambaqui em gaiolas de baixo volume: efeito da densidade de estocagem na produção de biomassa / Tambaqui farming in small volume cages: effects of stocking density on the biomass production

Fish farming in small floating cages is the subject of local discussions due to the possible sustainable use of the Amazon basin, alleviating poverty of people who live near lakes and rivers. Tambaqui is one of the main species indicated to this end because this is an omnivorous species, well accepted in the local market, whose demand grows fast due to the over-fishing around big western Amazon cities such as Manaus. However, more information about tambaqui farming in small volume cages is necessary to increase and advance production in this system. Therefore, we studied the effects of four stocking densities (10, 20, 30 and 40fish/m3) in tambaqui farming in small cages (1m3). We evaluated fish growth and number of gills parasites. The results showed clear fish biomass rise by the increase of tambaqui stocking density. No effect of stocking density was observed on fish individual growth, survival and number  of gills parasites.

A criação de peixes em gaiolas flutuantes na Amazônia Ocidental é um assunto de interesse inclusive governamental, pois traz à discussão a possibilidade do uso sustentável de grandes corpos de água da bacia amazônica, podendo, assim, beneficiar populações ribeirinhas com geração de trabalho e renda. O tambaqui é umas das espécies mais indicadas para esse fim por ser um peixe onívoro, bem apreciado no mercado consumidor local, além da demanda crescente, devido à redução dos estoques naturais pela pesca extrativista e desmatamento da mata ciliar nos arredores das grandes cidades nortistas como Manaus. Entretanto, mais informações básicas sobre a criação da espécie em gaiolas de baixo volume ainda são necessárias para o aperfeiçoamento e avanço da atividade. O presente trabalho estudou os efeitos de quatro densidades de estocagem (10, 20, 30 e 40 peixes/m3) no crescimento e na incidência de parasitas, monogêneas, nas brânquias do tambaqui cultivado em gaiolas de baixo volume (1m3). O estudo pode contribuir com mais informações elementares para a exploração racional dos recursos naturais amazônicos, o tambaqui e os grandes corpos de água. Os resultados mostram que é possível aumentar a produção de biomassa de tambaqui em gaiolas de baixo volume de 1m3 aumentando-se a densidade de estocagem até 40 peixes/m3,sem prejuízos no crescimento e aumento de carga parasitária nas brânquias dos peixes.

Diagnóstico de obesidad: métodos limitaciones y implicaciones / The diagnosis of obesity: methods, limitations and implications

Actualmente existen m¨¢s de mil millones de adultos con sobrepeso y aproximadamente 300 millones de ellos tienen obesidad. La obesidad se asocia como un factor de riesgo independiente y modificable para la hipertensi¨®n, dislipidemia, diabetes mellitus tipo 2, infarto al miocardio y enfermedad cerebrovascular. En 1995, la Organizaci¨®n Mundial de laSalud, defini¨® obesidad como el exceso de tejido adiposo con un IMC ¡Ý30 kg/m2 y sobrepeso con un IMC ¡Ý25 kg/m2. Varios estudios han descrito que el IMC presenta limitaciones para diagnosticar obesidad, ya que no distingue entre tejido adiposo y masa muscular. Obesidad central se define como acumulaci¨®n de tejido adiposo abdominal y es el tejido metabolicamente activo causante de la resistencia a la insulina y dislipidemia. Recientemente ha emergido un nuevo concepto denominado obesidad con peso normal, el cual se define en individuos con un IMC normal (18,5-24,9 kg/m2) y porcentaje de grasa corporal aumentado (>23,1 % en hombres; >33,3.% en mujeres), con riesgos significativos para enfermedad cardiovascular. El realizar el diagn¨®stico por un m¨¦dico, podr¨ªa llevar al individuoa intentar perder peso, por lo que se han desarrollado m¨¦todos relativamente simples, con uso en la pr¨¢ctica cl¨ªnica, como DEXA, bioimpedancia de m¨²ltiple frecuencia y pletismograf¨ªa con desplazamiento de aire. El IMC es uno de los m¨¦todos m¨¢s usados para el diagn¨®stico de la obesidad, pero con la introducci¨®n de estos nuevos m¨¦todos, el manejo de los individuos con obesidad o sobrepeso podr¨ªa ser m¨¢s adecuado y as¨ª contribuir a parar la creciente epidemia global de obesidad.

Nowadays, there are more than one thous and million overweight adults and at least 300 million have obesity. Obesity is associated as an independent and modifiable risk factor for hypertension, dyslipidemia, diabetes mellitus type 2, myocardial infarction and stroke. In 1995 the World Health Organization defined obesity as a BMI¡Ý30 kg/m2 and overweight as a BMI¡Ý25 kg/m2. In several studies, has been described the BMI has some limitations for the diagnosis of obesity, because it does not distinguish body adiposity from lean mass. Central obesity is defined as an excess of abdominal adiposity that is metabolically active, causing insulin resistance and dyslipidemia. Recently a new concept emerged, normal weight obesity, characterizing individuals with a normal BMI(18.5-24.9 kg/m2) and high body fat percentage (>23.1 % inmen; >33.3 % in women), who may have a higher prevalence of cardiovascular risk factors. The importance of diagnosing obesity in the doctor¡¯s office relies in that it may lead to weight loss. There are methods relatively simple to measure adiposity, like DEXA, multifrequency bioimpedance and air displacement plethysmography that may have a role in clinical practice. The BMI is one of the most used methods to diagnose obesity, although has some limitations, but with the new methods to measure adiposity, there could be a better way to manage obese or overweight individuals and therefore contribute to stop the global obesity epidemic.