Avaliação da eficácia, segurança e tolerabilidade da sibutramina em obesos - estudo randomizado duplo-cego

This is a double-blind, placebo-controlled study of the efficacy, safety, and tolerability of sibutramine in the management of obese patients for a 6-month period. METHOD: Sixty-one obese patients (BMI >;30, ;5% in 40% of the patients on sibutramine compared with 12.9% in the placebo group. We also detected weight gain in 45.2% of the placebo group compared to 20% in the sibutramine group. The sibutramine group showed improvement in HDL- cholesterol values (increased by 17%) and triglyceride values (decreased by 12.8%). This group also showed an increase in systolic blood pressure (6.7%, 5 mmHg). There were no changes in echocardiograms comparing the beginning and end of follow-up, and side effects did not lead to discontinuation of treatment. DISCUSSION: Sibutramine proved to be effective for weight loss providing an 8% loss of the initial weight. Compliance to prolonged treatment was good, and side effects did not result in discontinuation of treatment. These data confirmed the good efficacy, tolerability, and safety profiles of sibutramine for treatment of obesity.O presente estudo objetivou comparar a eficácia, segurança e tolerabilidade da sibutramina em pacientes obesos. MÉTODO: Selecionamos 61 pacientes obesos (3

Metabolic Syndrome in professional truck drivers who work on Highway BR-116 within the area of São Paulo City - Régis Bittencourt

O objetivo deste estudo foi determinar a prevalência da síndrome metabólica e identificar variáveis relacionadas a motoristas profissionais em trânsito na Rodovia BR-116. Foram avaliados 258 motoristas com medida do índice de massa corporal (IMC), circunferência abdominal, pressão arterial, triglicérides, colesterol total e frações e proteína C reativa. Avaliou-se a síndrome metabólica de acordo com a I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. O nível de significância adotado foi p < 0,05. Foram utilizadas as análises uni e multivariadas. Verificou-se que a idade dos motoristas foi de 37,5 ± 10,1 anos, 82% tinham IMC > 25 kg/m², 58% circunferência abdominal > 94 cm, 9% colesterol total > 240 mg/dL, 10% LDL-c > 160 mg/dL; 23% HDL-c < 40 mg/dL, 22% triglicérides > de 200 mg/dL, 7% glicemia > 110 mg/dL e 19% proteína C reativa > 0,5 mg/dL. A prevalência da hipertensão arterial foi de 37%, 9% apresentaram médio/alto escore de risco de Framingham e 24% com síndrome metabólica. A análise de regressão logística indicou a associação independente da síndrome metabólica para as variáveis: IMC (OR = 1,4007 IC 95% 1,192-1,661), hábito de verificar o colesterol (OR = 0,1020 IC 0,017-0,589) e escore de risco de Framingham (OR = 26,3 IC 2,520-276,374). Verificou-se presença expressiva de fatores de risco cardiovasculares e da síndrome metabólica na população estudada.The objective of this study was to determine the Metabolic Syndrome prevalence as well as identify variables related in truck drivers who work on Highway BR-116 (São Paulo, Brazil). A total of 258 truck drivers were assessed and the variables studied were: body mass index, waist circumference, blood pressure, triglycerides, total and fraction cholesterol, glycemia and C reactive protein. Cardiovascular disease risk was evaluated by Framingham's risk score whereas the Metabolic Syndrome based on the First Brazilian Guideline for Diagnosis and Treatment of the Metabolic Syndrome. The significance level adopted was p< 0.05 and univariate and multivariate analysis were applied. The average age was of 37.5±10.1. According to the anthropometric data, it was observed body mass index >25 kg/m² in 82%, waist circumference >94 cm in 58%, total cholesterol >240mg/dL in 9%, LDL-c >160mg/dL in 10%; HDL-c <40mg/dL in 20%, triglycerides >200mg/dL in 22%, glycemia >110mg/dL in 7%, and C reactive protein >0.5 mg/dL in 19%. Hypertension prevalence was 37%, 9% were identified at the highest/medium Framingham's risk score and 24% showed Metabolic Syndrome. The logistical regression analysis indicated independent association of the Metabolic Syndrome for the following variables (OD odds ratio, CI confidence interval at 95%): body mass index (OR = 1.4007 CI 95% 1.192-1.661), use to check cholesterol (OR = 0.1020 CI 0.017-0.589) and Framingham's risk score (OR = 26.389 CI 2.520-276.374). As a conclusion, it was observed a quite expressive prevalence of cardiovascular risk factors as well as Metabolic Syndrome in truck drivers

Body composition alterarions, energy expenditure and fat oxidation in elderly males suffering from prostate cancer, pre and post orchiectomy

INTRODUCTION: Testosterone is needed for normal male development, muscle strength, bone mineralization, hematopoietic function, and sexual and reproductive functions. The main purpose of androgen deprivation therapy in prostate cancer is to reduce tumor progression, but therapy is often accompanied by significant adverse effects. OBJECTIVE: This study aimed to determine the effects of androgen deprivation therapy on body composition and resting metabolic rate in patients with prostate cancer. PATIENTS AND METHODS: A prospective study was performed to evaluate the body composition of 16 elderly males (aged 63-96; median age 71) with prostate cancer scheduled for orchiectomy, one year before and after surgery. Body composition was measured by DEXA, and energy expenditure, fat and carbohydrate oxidation were measured by indirect calorimetry. RESULTS: Body weight (p=0.01), lean mass (p=0.004), and lipid oxidation (p=0.001) decreased significantly. Carbohydrate oxidation (p=0.02), FSH (p=0.0001) and LH (p=0.0001) levels increased significantly. Changes in fat mass (p=0.06) and bone mineral density (p=0.48) were not significant. CONCLUSIONS: After 12 months of androgen deprivation therapy, elderly men with metastatic prostate cancer exhibit a decline in lean body mass and lipid oxidation, together with increased carbohydrate oxidation

Body Composition Alterations, Energy Expenditure and Fat Oxidation in Elderly Males Suffering from Prostate Cancer, Pre and Post Orchiectomy

INTRODUCTION: Testosterone is needed for normal male development, muscle strength, bone mineralization, hematopoietic function, and sexual and reproductive functions. The main purpose of androgen deprivation therapy in prostate cancer is to reduce tumor progression, but therapy is often accompanied by significant adverse effects. OBJECTIVE: This study aimed to determine the effects of androgen deprivation therapy on body composition and resting metabolic rate in patients with prostate cancer. PATIENTS AND METHODS: A prospective study was performed to evaluate the body composition of 16 elderly males (aged 63-96; median age 71) with prostate cancer scheduled for orchiectomy, one year before and after surgery. Body composition was measured by DEXA, and energy expenditure, fat and carbohydrate oxidation were measured by indirect calorimetry. RESULTS: Body weight (p=0.01), lean mass (p=0.004), and lipid oxidation (p=0.001) decreased significantly. Carbohydrate oxidation (p=0.02), FSH (p=0.0001) and LH (p=0.0001) levels increased significantly. Changes in fat mass (p=0.06) and bone mineral density (p=0.48) were not significant. CONCLUSIONS: After 12 months of androgen deprivation therapy, elderly men with metastatic prostate cancer exhibit a decline in lean body mass and lipid oxidation, together with increased carbohydrate oxidation

Recent progress and novel perspectives on obesity pharmacotherapy

O aumento da prevalência da obesidade, nas últimas décadas, é alarmante, o que implica um grande número de pacientes sob risco de complicações metabólicas e cardiovasculares associadas. A eficácia modesta a longo prazo das modificações de estilo de vida isoladamente exige a necessidade de intervenções mais agressivas, seja por meio do uso adjuvante de medicamentos ou da abordagem mais radical cirúrgica. A cirurgia bariátrica, embora até hoje tenha se mostrado o método mais efetivo de tratamento dessa enfermidade, pode estar associada a complicações nutricionais e metabólicas ainda não totalmente esclarecidas. Contrasta com esse fato a disponibilidade limitada de agentes antiobesidade atualmente no mercado, além de fatos históricos que envolveram a suspensão de alguns fármacos previamente existentes, por questões de segurança. Este artigo tem como objetivo apresentar dados recentes de estudos clínicos de novas drogas propostas para o tratamento da obesidade com perspectivas breves de serem lançadas no mercado, caso passem pela aprovação das agências regulatórias. Nesta revisão serão discutidas a eficácia e a segurança desses fármacos, que incluem a lorcaserina (agonista serotoninérgico seletivo 5-HT2c), tesofensina (inibidor triplo de recaptação de monoaminas), liraglutide (análogo do GLP-1) e cetilistate (inibidor de lipases gastrointestinais), além das combinações de bupropiona/naltrexona, bupropiona/zonisamida, fentermina/topiramato e pramlintide/metreleptina.Obesity prevalence has risen dramatically over the past decades, which poses a great number of patients at risk of metabolic and cardiovascular complications. Long-term efficacy of lifestyle modification isolated has shown to be modest which, therefore, urges the need of more aggressive interventions such as adjuvant pharmacotherapy or the more radical surgical approach. Bariatric surgery has proven to date to be the most effective treatment, although it may be associated with nutritional and metabolic complications not yet completely recognized. By contrast, there is limited availability of antiobesity agents currently in the market, as well as historical facts involving the suspension of previously existing medications due to safety concerns. This article aims to present recent data on clinical trials of novel weight-loss drugs with short perspective to enter the market, if approved by the regulatory agencies. This review will discuss the efficacy and safety of these compounds, which include lorcaserin (selective serotonin 5-HT2c agonist), tesofensine (triple monoamine reuptake inhibitor), liraglutide (GLP-1 analogue) and cetilistat (gastrointestinal lipase inhibitor), as well as the combination therapies of bupropion/naltrexone, bupropion/zonisamide, phentermine/topiramate and pramlintide/metreleptin

Impacto da adiposidade nos parâmetros imunológicos

Studies evaluating immune function in obese humans and experimental animals indicate that the excess adiposity is associated with impaired in immune responses. Obesity is related to a higher rate of infections and to some types of cancer. Nutritional, metabolic and endocrine factors are implicated in the immunological changes. The adipose tissue directly produces substances with various functions related to immune system. Furthermore, some investigations suggest that certain types of weight reduction strategies can alter the immune function. Nevertheless, long-term studies should be carried out to address whether these changes positively affects the ability of these obese individuals to control infections and tumor development.Estudos acerca da função imunológica em animais experimentais e humanos obesos indicam que o excesso de adiposidade associa-se ao prejuízo da resposta imune. A obesidade está relacionada a uma taxa maior de infecções e a alguns tipos de câncer. Fatores nutricionais, metabólicos e endócrinos estão implicados nessas alterações imunológicas. O próprio tecido adiposo produz diretamente substâncias com várias funções relacionadas ao sistema imune. Além disso, algumas investigações sugerem que certas estratégias para perda de peso podem alterar a função imune. Entretanto, estudos em longo prazo são necessários para avaliar se tais alterações afetam positivamente a capacidade desses pacientes obesos de controlar infecções e desenvolver tumores

Is a diagnosis of metabolic syndrome applicable to children?

OBJETIVO: Abordar os componentes da síndrome metabólica (SM) na criança e no adolescente discutindo como eles são avaliados na população infantil e apresentando as principais classificações de SM nessa faixa etária. FONTES DOS DADOS: Revisão da literatura utilizando as bases de dados MEDLINE no período de 1986 a 2008. SÍNTESE DOS DADOS: A prevalência de obesidade infantil nas últimas décadas tem aumentado no mundo todo e, consequentemente, suas complicações, como diabetes melito, hipertensão arterial e dislipidemia. O conceito de SM, já usado em adultos, começa a ser aplicado em crianças por meio de classificações que utilizam os critérios para adultos modificados para faixas etárias menores. No entanto, essas classificações apresentam divergências quanto ao valor de pontos de corte usados nos critérios e quanto à utilização do índice de massa corporal ou da medida da circunferência abdominal para definir a obesidade. Esta revisão apresenta essas classificações mostrando os pontos discordantes e a discussão em torno delas. CONCLUSÕES: Se não for tratada, a obesidade infantil terá consequências graves no futuro. Alguns modelos de classificação de SM em crianças já foram apresentados, e observam-se consideráveis divergências entre eles. Assim, torna-se necessária a padronização desses critérios para a identificação dos indivíduos com maior risco de complicações futuras.OBJECTIVE: To present the components of the metabolic syndrome in children and adolescents and to discuss how they are assessed in the pediatric population in addition to presenting the major metabolic syndrome classifications for the age group. SOURCES: A review of literature published from 1986 to 2008 and found on MEDLINE databases. SUMMARY OF THE FINDINGS: The prevalence of childhood obesity has been increasing globally over recent decades and as a result its complications, such as diabetes mellitus, arterial hypertension and dyslipidemia, have also increased. The concept of metabolic syndrome, already common with adults, is now beginning to be applied to children through classifications using the criteria for adults modified for the younger age group. Notwithstanding, these classifications differ in terms of the cutoff points used and whether they employ body mass index or waist circumference to define obesity. The review presents these classifications, highlighting the points on which they differ and the debate about them. CONCLUSIONS: If childhood obesity goes untreated, it will have severe consequences in the future. A number of models for classifying metabolic syndrome in children have been published, but there is considerable diversions between them. The criteria for classifying metabolic syndrome in children therefore need to be standardized in order to identify those people at greatest risk of future complications

Efficacy and Tolerability of the Association of Sibutramine and Orlistat for Six Months in Overweight and Obese Patients

Objective. To assess the efficacy and tolerability of the association sibutramine (10–20 mg/day) and orlistat (120 mg 2-3 times a day) in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (−9.8% of the initial weight, n = 263), and after 6 months, the mean weight loss was 13.9 kg (−12.8% of the initial weight, n = 97). The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately