Obesidade e fatores de risco cardiovascular da adolescência à vida adulta

O objetivo desta tese é avaliar a associação entre obesidade e fatores de risco cardiovascular da adolescência à vida adulta. Para abordar essa temática foram realizados três estudos com delineamentos e fontes de dados distintos. O primeiro estudo que compõe esta tese investigou a prevalência de excesso de peso em adolescentes brasileiros e suas mudanças temporais por meio de uma revisão sistemática com metanálise. A busca na literatura recuperou 10.144 estudos, dos quais 151 foram incluídos na análise. Verificou-se aumento expressivo na prevalência de excesso de peso, sobrepeso e obesidade nas últimas décadas. A prevalência de excesso de peso encontrada foi de 8,2% (IC95% 7,7-8,7) até o ano 2000, 18.9% (IC95% 14,7-23,2) entre 2000 e 2010, e 25,1% (IC95% 23,4-26,8) após 2010. Também foram encontradas diferenças regionais significativas, com as regiões Sudeste e Sul apresentando as maiores prevalências gerais. O segundo estudo avaliou a associação entre o grau de obesidade e fatores de risco cardiometabólicos em adolescentes brasileiros participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). De um total de 37.892 indivíduos, 8.708 apresentaram excesso de peso, sendo 17,2% com sobrepeso, 5,6% com obesidade e 1,3% com obesidade severa. Foi observada associação do aumento da gravidade da obesidade com pior perfil cardiometabólico na amostra, mesmo após ajuste para múltiplas variáveis. O terceiro estudo investigou a associação entre níveis de NT-proBNP e risco de obesidade em adultos da coorte do Atherosclerosis Risk in Communities Study (ARIC). Dados de 9.681 participantes foram analisados, provenientes de duas visitas com seis anos de intervalo entre elas. Comparados com indivíduos no quartil de NT-proBNP mais elevado, aqueles no quartil mais baixo tinham maior chance de apresentar obesidade na visita inicial (OR 1,25; IC95% 1,08-1,45) e de desenvolver obesidade no seguimento (OR 1,35; IC95% 1,07-1,69). Diante dessas informações, conclui-se que o excesso de peso é importante problema de saúde pública que vem aumentando nos últimos anos entre adolescentes, causando inúmeros problemas de saúde que estão intimamente relacionados com o grau de obesidade. O estudo de novos fatores de risco para a obesidade, como os níveis de peptídeos natriuréticos, é necessário para o entendimento da etiologia da obesidade e possível prevenção por meio de intervenções precoces.The objective of this thesis is to evaluate the association between obesity and cardiovascular risk factors from adolescence to adulthood. To address this theme, three studies were carried out with different designs and data sources. The first study that composes this thesis investigated the prevalence of excess weight in Brazilian adolescents and its temporal changes through a systematic review with meta-analysis. The literature search retrieved 10,144 studies, of which 151 were included in the analysis. A significant increase in the prevalence of overweight, overweight and obesity in recent decades was observed. The prevalence of excess weight was 8.2% (95% CI 7.7-8.7) until the year 2000, 18.9% (95% CI 14.7-23.2) between 2000 and 2010, and 25.1% (95% CI 23.4-26.8) after 2010. Significant regional differences were also found, with the Southeast and South regions showing the highest overall prevalence. The second study evaluated the association between the degree of obesity and cardiometabolic risk factors in Brazilian adolescents participating in the Study of Cardiovascular Risks in Adolescents (ERICA). Of a total of 37,892 individuals, 8,708 had excess weight, being classified with overweight (17.2%), obesity (5.6%) and severe obesity (1.3%). It was observed that increasing severity of obesity was associated with a worse cardiometabolic profile in the sample, even after adjusting for multiple variables. The third study investigated the association between NT-proBNP levels and risk of obesity in adults in the Atherosclerosis Risk in Communities Study (ARIC) cohort. Data from 9,681 participants were analyzed, from two visits with a six-year interval between them. Compared with individuals in the highest NT-proBNP quartile, those in the lowest quartile were more likely to have obesity at the baseline (OR 1.25; 95% CI 1.08-1.45) and to develop obesity at follow-up (OR 1.35; 95% CI 1.07-1.69). Considering this information, it is concluded that weight excess is an important public health problem that has been increasing in recent years among adolescents, causing numerous health problems that are closely related to the degree of obesity. The study of new risk factors for obesity, such as levels of natriuretic peptides, is necessary to understand the etiology of obesity and possible prevention through early interventions

Six-year changes in N-terminal pro-brain natriuretic peptide and changes in weight and risk of obesity

Objective: The aim of this study was to study the prospective association between N-terminal pro-brain natriuretic peptide (NT- proBNP) and changes in weight and obesity risk in a community-based population. Methods: Data from 9,681 participants from the Atherosclerosis Risk in Communities Study were analyzed at two time points 6 years apart. Among people without obesity at baseline, multivariable logistic regression models were used to examine the association between baseline levels of NT-proBNP and incident obesity. A multivariable linear regression model was used to examine the association between changes in NT-proBNP (visit 2 serum and visit 4 plasma samples) and changes in weight. Results: The prevalence of obesity increased from 28% to 35% in the 6-year follow-up period. Compared with individuals in the highest NT-proBNP quartile, those in the lowest were more likely to have obesity at baseline (odds ratio 1.25; 95% CI: 1.08-1.45) and, among people who did not have obesity at baseline, were more likely to develop obesity at follow-up (odds ratio 1.35; 95% CI: 1.07-1.69). Changes in NT-proBNP were inversely associated with weight change. Conclusions: In this prospective study, lower levels of NT-proBNP were associated with higher risk of obesity, and changes in NT-proBNP were inversely associated with changes in weight. This suggests that natriuretic peptides or their pathways may be potential targets in the treatment of obesity

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents

Objective: To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. Methods: Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12–17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents (“ERICA”), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. Results: Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. Conclusion: Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS

Necrotizing fasciitis in the puerperium of a woman with complement deficiency : case report and review literature

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case

Homologous recombination in pestiviruses: Identification of three putative novel events between different subtypes/genogroups

AbstractViruses from the genus Pestivirus of the family Flaviviridae have a non-segmented, single-stranded RNA genome and can cause diseases in animals from the order Artiodactyla. Homologous recombination is rarely reported in this virus family. To detect possible recombination events, all complete pestivirus genomes that are available in GenBank were screened using distinct algorithms to detect genetic conversions and incongruent phylogenies. Three putative recombinant viruses derived from recombination from different pestivirus subtypes/genogroups were detected: Bovine viral diarrhea virus 1 (BVDV-1) strain 3156, BVDV-2 strain JZ05-1 and Classical swine fever virus (CSFV) strain IND/UK/LAL-290. The present study demonstrated that the pestivirus classification cannot be based only on the analysis of one fragment of the genome because genetic conversions can lead to errors. The designation of the recombinant forms (RF) provides a more informative structure for the nomenclature of the genetic variant. The present work reinforces that homologous recombination occurs in pestivirus populations under natural replication and describes the first evidence of recombination in BVDV-2