Long-Term Effects of Metformin and Lifestyle Modification on Nonalcoholic Fatty Liver Disease Obese Adolescents

Objective. To assess the long-term effects of metformin in combination with lifestyle intervention and its association between insulin levels and the degree of steatosis at ultrasonography (US) in obese adolescents. Methods. Thirty-five postpubertal obese boys were randomized into two groups: one receiving metformin in combination with a multidisciplinary lifestyle intervention versus a placebo group, which also received the same intervention. The visceral, subcutaneous fat and degree of steatosis were measured by ultrasonography. Fasting blood samples were collected to analyze glucose, insulin, insulin resistance, and aminotransferases. Repeated ANOVA measures were used to compare changes over time and between groups, and Spearman's correlations were used to identify an association between insulin and the degree of steatosis at US. Results. There was a positive correlation between the degree of steatosis at US with insulin concentrations and HOMA-IR. Long-term therapy plus metformin significantly reduced body weight, body mass index, insulin, HOMA-IR, and visceral fat. Conclusions. Metformin was more effective than the placebo in improving clinical parameters associated with obesity and steatosis

Improvement in HOMA-IR is an independent predictor of reduced carotid intima-media thickness in obese adolescents participating in an interdisciplinary weight-loss program

The aim of this study was to verify whether a 1-year interdisciplinary weight-loss program improved common carotid artery intima-media thickness (IMT) and whether insulin resistance and/or inflammation (as measured by the markers plasminogen activator inhibitor type-1 and adiponectin) might underlie obesity in adolescents. A group of 29 post-pubescent obese adolescents were submitted to an interdisciplinary intervention over the course of 1 year. Common carotid artery IMT was determined ultrasonographically. Body composition, blood pressure (BP), glycemia, insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile and adipokine concentrations were analyzed before and after the intervention. the interdisciplinary weight-loss program promoted a significant improvement in body composition, insulin concentration, HOMA-IR, lipid profile, BP and inflammatory state, in addition to significantly decreasing the common carotid artery IMT. Furthermore, this study demonstrated that the difference between baseline and final values of HOMA-IR (Delta HOMA-IR) was negatively correlated with concomitant changes in the adiponectin concentration (Delta adiponectin; r=-0.42; P=0.02) and positively correlated with changes in common carotid artery IMT (Delta carotid IMT; r=0.41; P=0.03). Multiple regression analysis adjusted by age, cardiovascular risk factors and inflammatory markers showed that Delta HOMA-IR was an independent predictor of significant changes in common carotid artery IMT. This investigation demonstrated that an interdisciplinary weight-loss program promoted a reduction of the common carotid artery IMT in obese Brazilian adolescents, and the improvement of HOMA-IR was an independent predictor of carotid IMT changes in this population. Hypertension Research (2011) 34, 232-238; doi: 10.1038/hr.2010.225; published online 2 December 2010AFIPFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)CENESPFADAUNIFESP-EPMUniversidade Federal de São Paulo, Postgrad Program Nutr, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, São Paulo, BrazilUniversidade Federal de São Paulo, Postgrad Program Nutr, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, São Paulo, BrazilFAPESP: 2006/00684-3FAPESP: 2008/53069-0FAPESP: 9814303-3 S.TWeb of Scienc

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy

© 2009 Lofrano-Prado et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

A influência da gordura visceral e subcutânea na densidade mineral óssea de adolescentes obesos

OBJECTIVE: To verify the influence of visceral and subcutaneous fat, as well adipokines in bone mineral density (BMD) in obese adolescents. SUBJECTS AND METHODS: The study involved 125 postpubertal obese adolescents (45 boys and 80 girls). Anthropometric measurements, body composition, visceral and subcutaneous fat, and BMD were determined. Leptin, adiponectin, and insulin levels also analyzed. RESULTS: Data demonstrated a negative relationship between BMD with insulin resistance, visceral fat and leptin concentration; and bone mineral content with visceral/subcutaneous ratio. Positive association between BMD and subcutaneous fat was observed. CONCLUSIONS: Visceral fat and insulin resistance, as well as visceral/subcutaneous ratio and leptin concentration, were negative predictors of BMD in boys and girls, respectively. However, subcutaneous fat had a protective influence in BMD only in boys.OBJETIVO: Verificar a influência da gordura visceral e subcutânea, assim como das adipocinas na densidade mineral óssea (DMO) em adolescentes obesos. SUJEITOS E MÉTODOS: O estudo envolveu 125 adolescentes obesos pós-púberes. Medidas antropométricas, composição corporal, gordura visceral e subcutânea e DMO foram determinadas. Níveis de leptina, adiponectina e insulina foram analisados. RESULTADOS:Os dados demonstraram associação negativa entre DMO com resistência insulínica, gordura visceral e concentração de leptina; e conteúdo mineral ósseo com a razão visceral/subcutânea. Associação positiva entre DMO e gordura subcutânea foi observada. CONCLUSÕES: Gordura visceral, resistência insulínica, razão visceral/subcutânea e concentração de leptina foram preditores negativos da DMO em meninos e meninas, respectivamente. Entretanto, a gordura subcutânea demonstrou exercer influência positivamente na DMO somente nos meninos.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Graduate Studies Program in NutritionUNIFESP Endocrinology DepartmentUNIFESP Psychobiology DepartmentUNIFESP Graduate Studies Program in Interdisciplinary Health SciencesUNIFESP Biosciences DepartmentUNIFESP, Graduate Studies Program in NutritionUNIFESP, Endocrinology DepartmentUNIFESP, Psychobiology DepartmentUNIFESP, Graduate Studies Program in Interdisciplinary Health SciencesUNIFESP, Biosciences DepartmentSciEL

Previous results of semipresential multiprofessional intervention, with an approach to a behavioral treatment in obesity / Resultados anteriores da intervenção multiprofissional semipresencial, com abordagem de tratamento comportamental na obesidade

AIM: Obesity is recognized as an important multifactorial disease and the Cognitive-Behavioural Therapy (CBT), based on reflection on conflicts with food, has been used in a way associated with interdisciplinary clinical therapies, aiming to promote greater understanding, self-efficacy and autonomy of treated individuals. In this context, the objective of this investigation was to analyse the impact of behavioural nutritional intervention using the MTT (Transtheoretical Model); associated with non-intensive interdisciplinary clinical therapy, including digital health education. METHODS: The research was approved by the Research Ethics Committee of University Federal of São Paulo (n º 0242/2017). The 60 selected volunteers (BMI ~34.7Kg/m2) were conducted to an interdisciplinary lifestyle therapy, with duration of 12 weeks. This therapy included clinical, nutritional and exercise physiology approach associated to digital health education. At the beginning (week 0) and after the 12 weeks an anthropometric evaluation was performed and a biochemical profile analysis as well as evaluation of the stage of behavior change according to Prochaska and Diclemente. Statistical analysis was performed adopting as significant values p ? 5%. RESULTS: there was an increased degree of motivation and a reduction in the frequency of volunteers in the Relapse and Pre-Contemplation stages, as well as an increase in the number of women classified in the Action stage.The decision-categorized group had a statistically significant reduction on body weight (p = 0.00), BMI (p = 0.00), Neck Circumference (p = 0.00), Waist Circumference (p = 0.02), Abdominal Circumference (p = 0.03), Hip Circumference (p = 0.02) Body Fat Percentage (p = 0.00), Total Cholesterol (p = 0.02) and Non-HDL Cholesterol (p = 0.04). In the Action and Maintenance group, there was a significant reduction in body weight (p = 0.00), BMI (p = 0.01), Neck Circumference (p=0.00), Waist Circumference (p= 0.00), Abdominal Circumference (p = 0.00) and Hip Circumference (p = 0.00). CONCLUSION: the semi-presential clinical approach was effective to promote improvements in the body composition, including body fat and lipid profile, as a dependent manner considering the identification of the stage of behavior change. 

A new paradigm for Aedes spp. surveillance using gravid ovipositing sticky trap and NS1 antigen test kit

BACKGROUND:Dengue remains a serious public health problem in Southeast Asia and has increased 37-fold in Malaysia compared to decades ago. New strategies are urgently needed for early detection and control of dengue epidemics. METHODS:We conducted a two year study in a high human density dengue-endemic urban area in Selangor, where Gravid Ovipositing Sticky (GOS) traps were set up to capture adult Aedes spp. mosquitoes. All Aedes mosquitoes were tested using the NS1 dengue antigen test kit. All dengue cases from the study site notified to the State Health Department were recorded. Weekly microclimatic temperature, relative humidity (RH) and rainfall were monitored. RESULTS:Aedes aegypti was the predominant mosquito (95.6%) caught in GOS traps and 23% (43/187 pools of 5 mosquitoes each) were found to be positive for dengue using the NS1 antigen kit. Confirmed cases of dengue were observed with a lag of one week after positive Ae. aegypti were detected. Aedes aegypti density as analysed by distributed lag non-linear models, will increase lag of 2-3 weeks for temperature increase from 28 to 30 °C; and lag of three weeks for increased rainfall. CONCLUSION:Proactive strategy is needed for dengue vector surveillance programme. One method would be to use the GOS trap which is simple to setup, cost effective (below USD 1 per trap) and environmental friendly (i.e. use recyclable plastic materials) to capture Ae. aegypti followed by a rapid method of detecting of dengue virus using the NS1 dengue antigen kit. Control measures should be initiated when positive mosquitoes are detected

Surveillance of adult Aedes mosquitoes in Selangor, Malaysia

Objective To determine the effectiveness of using sticky traps and the NS1 dengue antigen kit for the surveillance of Aedes mosquitoes for dengue control. methods Apartments were selected in a dengue-endemic area, and sticky traps were set to capture adult Aedes mosquitoes. NS1 dengue antigen kit was used to detect dengue antigen in mosquitoes, and positive mosquitoes were serotyped using real-time RT-PCR. results The sticky traps were effective in capturing Aedes aegypti, and a minimum of three traps per floor was sufficient. Multiple serotypes were found in individual mosquitoes. conclusion The sticky trap and the NS1 dengue antigen test kit can be used as surveillance tool in dengue control programmes. This proactive method will be better suited for control programmes than current reactive methods