Effect of a concurrent training on risk factors for the accumulation of hepatic fat of obese adolescents

Modelo de estudo: Estudo prospectivo. Objetivo: Avaliar o efeito de um protocolo de treinamento concorrente com duração de 16 semanas sobre fatores de risco para o acúmulo de gordura hepática de jovens obesos. Metodologia: A amostra foi formada por 38 indivíduos obesos de ambos os sexos e com idade entre 12 e 15 anos. A obesidade foi atestada pelo percentual de gordura corporal, o qual foi estimado pela absortometria radiológica de dupla energia (DEXA). Adicionalmente, a quantidade de gordura localizada no tronco (kg) foi estimada também. Antes e após a intervenção, os jovens foram submetidos a exames bioquímicos de sangue(perfil lipídico completo em jejum [mg/dL]) e a ultrassonografia do fígado (tamanho dos lobos direito [LD em cm] e esquerdo [LE em cm]). A Intervenção consistiu de treinamento concorrente (treino resistido [30 minutos] e aeróbio [30 minutos]) com três sessões semanais, totalizando 180 minutos por semana. A análise estatística foi composta pelo teste t de Student para dados pareados, utilizando o software SPSS (17.0), e significância estatística fixada em p<5%. Resultados: Após a intervenção, foram observadas melhoras significantes no percentual de gordura total (PRÉ: 45,1±5,3 e PÓS: 41,7±5,6; p= 0,001) ena região do tronco (PRÉ: 46,5±5,6 e PÓS: 42,9±6,3; p= 0,001). Para o perfil lipídico, houve redução no colesterol total (PRÉ: 164±34 e PÓS: 148±29; p= 0,001), triglicérides (PRÉ: 118±59 e PÓS: 104±53; p=0,002) e lipoproteínas de baixa densidade (PRÉ: 100±29 e PÓS: 85±26; p= 0,001), porém, não para as de alta densidade (p= 0,981). Tanto o LE (PRÉ: 8,8±1,4 e PÓS: 7,8±1,3; p= 0,001) como o LD (PRÉ:13,6±1,3 e PÓS: 12,9±1,1; p= 0,001) sofreram diminuição em suas proporções. Conclusão: Em jovens obesos, o treinamento concorrente foi eficiente no combate a alguns fatores de risco ao acúmulo de gordura no fígado, bem como, na redução da gordura em ambos os lobos do órgão.Study Design: Prospective study. Objective: To evaluate the effect of a protocol of concurrent training lasting 16 weeks on risk factors for the accumulation of hepatic fat in obese youth. Methods: 38 obese children and adolescents of both sexes, between 12 and 15 years old. The obesity was attested by the percentage of body fat, which was estimated by dual-energy X-ray absorptiometry (DEXA). Additionally, the amount of fat located in the trunk (kg) was estimated too. Before and after the intervention, the youths underwent biochemical blood tests (fasting complete lipid profile [mg / dL]) and ultrasonography of the liver (right size Wolves [LD cm] and left [LE in cm]). The intervention consisted of concurrent training (strength training [30 minutes] and endurance training [30 minutes]) with three sessions per week, totaling 180 minutes a week, for ten weeks. Statistical analysis was made by the test t of Student for paired data using SPSS software (17.0) and significance statistical fixed at p <5%. Results: After the intervention, significant improvements were observed in the percentage of total fat (PRE: 45.1 ± 5.3 and POST: 41.7 ± 5.6, p = 0.001) and in the trunk region (PRE: 46, 5 ± 5.6 and POST: 42.9 ± 6.3, p = 0.001). For lipid profile, reduction in total cholesterol (PRE: 164 ± 34 and POST: 148 ± 29, p = 0.001), triglycerides (PRE: 118 ± 59 and POST: 104 ± 53, p = 0.002) and lipoproteins density (PRE: 100 ± 29 and POST: 85 ± 26, p = 0.001), but not for high-density (p= 0.981). Both the LE (PRE: 8.8 ± 1.4 and POST: 7.8 ± 1.3, p = 0.001) and LD (PRE: 13.6 ± 1.3 and POST:12.9 ± 1, 1, p = 0.001) experienced a decrease in its proportions. Conclusion: The concurrent trainingwas effective in combating some risk factors to the accumulation of fat in the liver, as well as in reducing fat in both lobes of the organ in young obese

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Efeito de um protocolo de treinamento concorrente sobre fatores de risco para o acúmulo de gordura hepática de adolescentes obesos

Study Design: Prospective study Objective: To evaluate the effect of a protocol of concurrent training lasting 16 weeks on risk factors for the accumulation of hepatic fat in obese youth. Methods: 38 obese children and adolescents of both sexes, between 12 and 15 years old. The obesity was attested by the percentage of body fat, which was estimated by dual-energy X-ray absorptiometry (DEXA). Additionally, the amount of fat located in the trunk (kg) was estimated too. Before and after the intervention, the youths underwent biochemical blood tests (fasting complete lipid profile [mg / dL]) and ultrasonography of the liver (right size Wolves [LD cm] and left [LE in cm]). The intervention consisted of concurrent training (strength training [30 minutes] and endurance training [30 minutes]) with three sessions per week, totaling 180 minutes a week, for ten weeks. Statistical analysis was made by the test t of Student for paired data using SPSS software (17.0) and significance statistical fixed at p <5%. Results: After the intervention, significant improvements were observed in the percentage of total fat (PRE: 45.1 ± 5.3 and POST: 41.7 ± 5.6, p = 0.001) and in the trunk region (PRE: 46, 5 ± 5.6 and POST: 42.9 ± 6.3, p = 0.001). For lipid profile, reduction in total cholesterol (PRE: 164 ± 34 and POST: 148 ± 29, p = 0.001), triglycerides (PRE: 118 ± 59 and POST: 104 ± 53, p = 0.002) and lipoproteins density (PRE: 100 ± 29 and POST: 85 ± 26, p = 0.001), but not for high-density (p = 0.981). Both the LE (PRE: 8.8 ± 1.4 and POST: 7.8 ± 1.3, p = 0.001) and LD (PRE: 13.6 ± 1.3 and POST: 12.9 ± 1, 1, p = 0.001) experienced a decrease in its proportions. Conclusion: The concurrent training was effective in combating some risk factors to the accumulation of fat in the liver, as well as in reducing fat in both lobes of the organ in young obese

The effects of combined aerobic and resistance training on heart rate variability in postmenopausal women

Model of the study: Controlled clinical trial. Objective: To verify the effects of 16 weeks of combined aerobic and resistance training on cardiac autonomic modulation in menopausal women. Methods: 17 menopausal women were divided into two groups: the training group (TG: n=11) and control group (CG: n=6). The body composition variables were estimated using dual-energy X-ray absorptiometry. The cardiac autonomic modulation was evaluated by heart rate variability using linear indexes. The training protocol consisted of 16 weeks of 50 minutes of resistance training and 30 minutes of aerobic training. Results: For the TG there was an increase in the rMSSD(ms) index (pre:17,4±3,7 and post:24,8±13,1, p<0,045), an increase in the duration of the intervals between the cardiac beats(ms) (pre:891,2±80,2 and post:974,1±71,4, p<0,003) and in the values of heart rate(bpm) (pre:68,1±6,4 and post:62,0±4,7, p<0,003), additionally for the spectral indexes in normalized units, changes for LF (pre:52,2±13,1 and post:44,5±12,4, p<0,025) and HF (pre:47,8±13,3 and post:55,5±12,4, p<0,025) were noticed, demonstrating increased parasympathetic and reduced sympathetic. There were no significant differences to CG. Conclusion: combined aerobic and resistance training promoted benefits to the autonomic modulation in menopausal women

Associação entre fatores de risco cardiovascular e capacidade funcional de idosos longevos

Study design: cross-sectional study. Objective: To assess the association between the presence of cardiovascular risk factor (CRP) and functional capacity of the oldest old. Methods: The sample 9onsisted of 91 elderly aged 80 and 90 years (83.0 ± 2.5 years) with 60 women (82.2 ± 2.1 years) and 31 men (83.2 ± 2,6 years) residing in the city of Presidente Prudente - SP. The FRC were analyzed: arterial hypertension (AH) and excess body fat (total and trunk). The presence of hypertension was verified by means of self-reported questionnaire based on the Standard Health Questionnaire (SHQ). Assessment of body was made by absorpiometria dual energy X-ray absorptiometry (DXA) and functional capacity was assessed by the functional tests (static balance, normal walking speed and force of the lower limbs). For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%. Results. In males, with hypertension and the presence of excess %BF had lower performance in the lower limbs (83.3% lower and 16.7% higher), p = 0.011 compared to those with only a VCF. The elderly women with hypertension and the presence of excess GTron% also had lower performance on the same test (80.6% lower and 19.4% higher), p = 0.018 and the test of walking speed (80.6% lower and 19.4% higher), p = 0.034. Conclusion: Arterial hypertension and excess body fat (total and trunk) aggregated are FRC, which are associated with reduced functional capacity of the oldest old

Performance of body fat and body mass index cutoffs in elevated blood pressure screening among male children and adolescents

For percentage of body fat (%BF), there are no internationally accepted cutoffs. The primary function of body fat cutoffs should be to identify not only excessive body fatness, but also the increased risk of unhealthy outcomes, such as hypertension. The purpose of this study was to analyze the accuracy of different %BF and body mass index (BMI) cutoffs as screening measures for EBP in pediatric populations. It was a cross-sectional study with a sample of 358 male subjects from 8 to 18 years old. BP was measured by the oscilometric method, and body composition was measured by dual-energy X-ray absorptiometry (DXA). The accuracy of three reference tables used for body fat cutoffs was assessed. The three body fat reference tables were highly specific, but insensitive, for elevated BP screening. For elevated BP screening, all body fat cutoffs presented similar sensitivity (range=48.3-53.7%) and specificity (range=79.2-84.1%). The body fat cutoffs performed no better than BMI in screening of children and adolescents at risk of elevated BP (EBP). BMI seems a more attractive tool for this function, as it performed similarly and can be applied in large surveys and with lower costs. Hypertension Research (2011) 34, 963-967; doi:10.1038/hr.2011.61; published online 26 May 2011CAPES (Coordenadoria de Aperfeicoamento do Pessoal de Nivel Superior