Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis

To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: “overweight” OR “obesity” AND “indigenous” OR “tribe” AND “Brazil”. For the meta-analysis, RStudio^® software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.     

Heart failure symptom clusters and quality of life

BackgroundHeart failure (HF) is a progressive symptomatic illness with reports suggesting that patients experience multiple symptoms. Symptom clusters constitute symptoms that co-occur, are related, and influence outcomes.ObjectivesThe specific aims of this study were to (1) examine prevalent symptoms experienced by persons with HF, (2) identify symptoms forming clusters, and (3) evaluate the impact of HF symptom clusters on quality of life (QOL).Methods117 participants (62% male; 50% black; age = 56) were recruited. Prevalent symptoms were evaluated; principle components analysis (PCA) was used to extract symptom clusters; regression analysis was used to evaluate factors influencing QOL, defined as life satisfaction.ResultsThree symptom clusters–sickness behavior, discomforts of illness, and GI distress–were extracted. Sickness behavior significantly influenced QOL (β = ?0.603 p = 0.0001), explaining 40% of the variance (F = 75.12; R² = 0.404; p = 0.0001).ConclusionsThe Sickness Behavior cluster had a negative impact on QOL and suggests that incorporating an evaluation of these symptoms may facilitate identification and treatment of symptoms having an additive and detrimental influence on QOL. Studies to examine the stability of the clusters are warranted.     

Xanthine oxidase activity in type 2 diabetic Nigerians

AimThis study evaluated the activity of xanthine oxidase in Nigerians with type 2 diabetic mellitus as well as its relationship with lipid peroxidation, inflammatory bio markers and glycemic control indices.MethodsTwo hundred and thirty seven (237) subjects, comprising of one hundred and fifty seven (157) DM subjects and eighty (80) aged matched controls participated in this study. Blood samples were collected from the participants for the estimations of xanthine oxidase activity, uric acid, malon diadehyde (MDA), erythrocyte sedimentation rate (ESR), high sensitive c – reactive protein (hs CRP), glucose, fructosamine and glycosylated hemoglobin by standard methods.ResultsThe results of this study showed a significantly increased activity of xanthine oxidase in DM (0.044 ± 0.05μ/mg) compared with apparently healthy controls (0.028 ± 0.00 μ/mg). The mean plasma levels of MDA (42.40 ± 2.50μmol/l) and uric acid (7.22 ± 0.20 mg/dl) in DM were significantly higher (p ≤ 0.05) than healthy non DM group. The mean levels of hs CRP in DM (4.09 ± 0.91μg/ml) was significantly higher than controls (1.30 ± 0.50μg/ml, p = 0.009). While no association of xanthine oxidase was observed with glycemic control indices and hs CRP, a negative association of xanthine oxidase was observed with MDA (r = ?0.514, p = 0.000).ConclusionIncreased activity of xanthine oxidase in DM was associated with increased lipid peroxidation and could be a salient entity towards the onset on complications.     

Hyponatremia in systemic lupus erythematosus patients: Relation to disease activity and fatigue

Aim of the workTo investigate the relation of hyponatremia to disease activity and fatigue in systemic lupus erythematosus (SLE) patients.Patients and methodsThe present study included 30 SLE patients with hyponatremia and 70 with normal serum sodium (Na) level. SLE disease activity index and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score were assessed.ResultsThe gender, age and disease duration of SLE patients with hyponatremia (26 females and 4 males; mean age 37.8 ± 9.3 years, 10.9 ± 5.1 years) were comparable with those without (60 females and 10 males; 36.9 ± 11.8 years, 11.1 ± 6.02; p = 0.71 and p = 0.9 respectively). SLE patients with hyponatremia showed significantly increased SLEDAI (14.2 ± 3.85 vs 3.86 ± 3.59; p < 0.001), ESR (55.2 ± 18.2 vs 14.70 ± 3.5 mm/1st h; p < 0.001) and CRP (30.97 ± 4.4 vs 5.17 ± 2.6 mg/dl; p < 0.001) and lower FACIT-Fatigue (21.99 ± 2.1 vs 35.87 ± 4.81; p < 0.001) compared to patients without. Serum Na levels significantly correlated with the FACIT-fatigue score (r = 0.99, p < 0.01), platelets (r = 0.22; p = 0.03), white blood cells count (r = 0.31, p < 0.001) and inversely with SLEDAI (r = ?0.27, p = 0.01), ESR (r = ?0.71; p < 0.001), CRP (r = ?0.86, p < 0.001), anti-ds-DNA (r = 0.54, p < 0.001), C3 (r = ?0.29, p = 0.01) and C4 (r = ?0.2, p = 0.04). On regression, CRP (β = 0.3), SLEDAI (β = 0.28) and consumed C4 (β = ?0.07) were significant independent risk factors for hyponatremia (p < 0.0001, p = 0.0005, p = 0.02 respectively). The optimal cut-off values to predict hyponatremia was a SLEDAI score ≥11 (90% sensitivity and 96% specificity), and ESR ≥ 17.5 mm/1st h (100% sensitivity and 80% specificity) and a CRP of ≥10.5 mg/dl (100% sensitivity and 97% specificity).ConclusionHyponatremia in SLE patients is associated with higher disease activity and more perceived fatigue. Hyponatremia could reflect severe inflammation and could be considered as one of the predisposing factors of fatigue.     

An update on metabolic syndrome: Metabolic risk markers and adipokines in the development of metabolic syndrome

BackgroundMetabolic syndrome is a collection of physiological and biochemical abnormalities about 20–25% of adult population in developing countries is suffering from metabolic syndrome. Previous research demonstrated that adipose tissue plays an important role in energy regulation via endocrine, paracrine and autocrine signals as results of obesity due to accumulation of adipose tissue to excess that by time affects negatively both physical and psychological health and well being, it has been found that adipose tissues produces a variety of factors known as “adipokines” which play a key role in the development and progression of the disease and also hypothesized that adipokines are a possible link between obesity and the other risk components of the Metabolic syndrome. Many of the adipokines exert multiple actions in a variety of cellular processes leading to a complex array of abnormal characteristic of Metabolic syndrome. Abnormal production of these adipokines by expanded visceral fat during Adiposity contributes to a pro-inflammatory state. Increasing evidence suggests that aberrant production/release of adipokine from adipocyte i.e. adiponectin, leptin and resistin etc, may contribute to the health problems associated with Adiposity such as dyslipidemia, insulin resistance and atherosclerosis. This study conclusively have shown a significant role of adipokines secreted by adipose tissue and various metabolic risk markers play a important role in the development of Metabolic syndrome.     

Presentation and diagnosis of patients with type 3 von Willebrand disease in resources-limited laboratory

Von Willebrand disease (VWD) is a bleeding disorder that results from decreased von Willebrand factor (VWF) activity <0.30 iu/mL. Therefore, the diagnosis of type 3 VWD in patients with bleeding requires finding a VWF:Ag and/or VWF:platelet ristocetin cofactor (RiCof) <0.03 iu/mL, no further testing is usually necessary. This is a cohort study that included 64 patients with type 3 VWD who were presented and diagnosed at the National Center of Hematology (NCH) from October 2014 to October 2016. In this study the sensitivity of VWF:Ag is only 78%, the sensitivity of VWF:RiCof is 92% of diagnosed cases. From our results it can be concluded that patients with type 3 VWD are usually presented with moderate/severe mucocutaneous bleeding that is associated with prolonged bleeding time test of >10 min and a family history of similar type of bleeding. This fact was frequently utilized to provisionally diagnose several members of the same family, forming a cohort of patients that is larger than the number of objectively-diagnosed patients included in this study, when they cannot afford to be all tested with VWF:Ag/VWF:RiCof.     

成年早期体重变化影响远期心血管代谢性疾病的研究现状

成年早期是生命周期中的关键阶段,这一时期的体重变化具有显著的生理特点,并可能对远期的心血管代谢健康水平造成潜在影响。然而,目前鲜见对于成年早期体重变化影响远期心血管代谢风险的系统阐述。因此,本综述试图总结成年早期不同体重变化模式对远期心血管代谢性疾病的具体作用,并提出未来相关研究的可能方向。     

Six-minute walk test before and after large-volume paracentesis in cirrhotic patients with refractory ascites: A pilot study

Background/AimsFunctional impairment is common among cirrhotic patients with refractory ascites, and improvement in functional impairment is an expected issue after paracentesis. The six-minute walk test (6MWT) is considered an objective test for functional activity. No published data have evaluated the 6MWT among cirrhotic patients with refractory ascites before and after large-volume paracentesis. The research aim was to assess the feasibility of performing the 6MWT among cirrhotic patients who had refractory ascites before and after large-volume paracentesis.Materials and MethodsThirty-one cirrhotic inpatients with refractory ascites were subjected to pulmonary function tests (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], FEV1/FVC) and diffusion lung capacity for carbon monoxide (DLCO) before and 48 h after therapeutic large-volume paracentesis. Dyspnoea as assessed by the Borg scale and functional capacity as assessed by the 6MWT were also evaluated.ResultsPrior to paracentesis, the mean values of FVC and FEV1 were lower than the predicted values, and a significant increase was observed after paracentesis. There was improvement in the mean DLCO values after paracentesis (P < 0.05). Regarding the 6MWT, significant increases in the walked distance (6MWD) (310.7 ± 73 vs. 348.7 ± 72.3 m) and oxygen saturation after paracentesis (P = 0.001) were observed. Significant improvement in the dyspnoea scale also occurred after paracentesis (P = 0.001). A significant positive correlation between the 6MWD before paracentesis and serum albumin levels was demonstrated (r = 0.373, P = 0.039).ConclusionWe found a decrease in pulmonary function and the 6MWD in patients who had refractory ascites, which improved significantly following large-volume paracentesis. The 6MWT is useful in detecting impaired functional capacity among cirrhotic patients.     

Budesonide up-regulates vitamin D receptor expression in human bronchial fibroblasts and enhances the inhibitory effect of calcitriol on airway remodeling

Introduction and objectivesTransforming growth factor β1 (TGFβ1) and dysregulated microRNA-21 (miR-21) expression is associated with TGFβ/Smad signaling pathway activation and fibrosis. While calcitriol has been shown to improve airway remodeling in asthmatic mice, its mechanism remains unknown. In this study, the effect of calcitriol on the TGFβ/Smad signaling pathway and miR-21 expression in human bronchial fibroblasts was investigated to explore the mechanism of action of calcitriol and the inhaled glucocorticoid, budesonide, in airway remodeling.Materials and methodsHuman bronchial fibroblasts were pretreated with budesonide, calcitriol, or budesonide plus calcitriol, and stimulated with TGFβ1 for 48 h. Quantitative real-time PCR was used to determine the expression of miR-21. Western blot was used to determine airway remodeling-related proteins, TGFβ/Smad signaling pathway-related proteins, glucocorticoid receptor, and vitamin D receptor (VDR) expression.ResultsBoth budesonide and calcitriol down-regulated miR-21 expression in human bronchial fibroblasts, up-regulated Smad7 expression, and inhibited the expression of airway remodeling-related proteins. Both budesonide and calcitriol up-regulated the low expression of VDR induced by TGFβ1 in human bronchial fibroblasts. The expression of VDR in the combined treatment group (budesonide plus calcitriol) was significantly higher than that in the calcitriol treatment group. The expression of collagen type I in the combined treatment group was significantly lower than that in the calcitriol treatment group.ConclusionsCalcitriol can up-regulate the expression of VDR in human bronchial fibroblasts and exert an anti-airway remodeling effect. Budesonide can up-regulate the expression of VDR in human bronchial fibroblasts and enhance the inhibitory effect of calcitriol on airway remodeling.     

Cardiometabolic risk in overweight subjects with or without relative fat-free mass deficiency: The Strong Heart Study

Background and aimSarcopenia is a condition mainly due to loss of fat-free mass (FFM) in elderly individuals. RFFMD, however, is also frequent in obese subjects due to abnormal body composition. Objective of this study was to evaluate the impact of relative fat-free mass deficiency (RFFMD) on cardiometabolic (CM) risk in obese normoglycemic individuals.Methods and resultsOverweight/obese American Indians from the Strong Heart Study population, without diabetes and with FBG ≤110 mg/dL and with GFR >60 mg/mL/1.73 m² were selected for this analysis (n = 742). RFFMD was defined on the basis of a multivariable equation previously reported. Fasting glucose and 2 h-OGTT were measured together with urine albumin/creatinine excretion, laboratory and anthropometric parameters. In addition to lower FFM and greater adipose mass, participants with RFFMD had higher body mass index, waist circumference, C-reactive protein, fibrinogen, insulin resistance and urinary albumin/creatinine than participants with normal FFM (all p < 0.001); they also had a greater prevalence of hypertension, impaired glucose tolerance (IGT) or OGTT-diabetes than participants with normal FFM (all p < 0.003) and a near 2-fold greater probability of significant proteinuria (p < 0.01). RFFMD was more frequent in women than in men: significant sex-RFFMD interactions were found for BMI and waist circumference (both p < 0.0001).ConclusionsRFFMD in overweight/obese normoglycemic individuals is associated with greater probability of hypertension, abnormalities of glucose tolerance and proteinuria. Assessment of RFFRMD might, therefore, help stratifying cardiometabolic risk among normoglycemic individuals with overweight/obesity.     

Incidence and predictors of super-response to cardiac resynchronization therapy

ObjectivesCardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed “super-responders”. The characteristics of this subset of patients in Indian and Asian population have not been well studied. In this study, we sought to assess the prevalence and clinical characteristics of this cohort of patients.MethodsThis was a retrospective study involving patients undergoing CRT. Changes in ejection fraction and LVESV at the end of one year of follow-up following device implantation were assessed, and patients were stratified into non-responders, responders, and super-responders. Responders had a 15–29% decrease in LVESV while super-responders had a >30% decrease in LVESV.ResultsOf the 74 patients who had undergone CRT-P/CRT-D implantation, 16 patients did not have echocardiograms at the end of one year of follow-up and were excluded from the analysis. Thus, 58 patients were enrolled for analysis. We identified 16 patients (27.6%) to be super-responders, 26 patients (44.8%) to be responders, and 16 patients (27.6%) to be non-responders. Factors associated with a super-response were a diagnosis of dilated cardiomyopathy as against ischemic cardiomyopathy (93.7% vs 6.3%; p – 0.01), prior right ventricular (RV) apical pacing (25% vs 2.4%; p – 0.02) and absence of a prior history of myocardial infarction (MI) (0% vs 33.3%; p – 0.02).ConclusionIn our study, 27.6% of patients were super-responders, and a diagnosis of dilated cardiomyopathy, absence of a prior history of MI and prior RV apical pacing predicted a super-response to CRT.     

The effects of mobile health interventions on lipid profiles among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThe current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of mobile health (m-health) interventions on lipid profiles among patients with metabolic syndrome and related disorders.MethodsCochrane Library, EMBASE, PubMed, and Web of Science databases were searched to indentify the relevant randomized clinical trials published up April 30^th, 2018. Two reviewers examined study eligibility, extracted data, and assessed risk of bias of included clinical trials, individually. Heterogeneity was measured using I-square (I²) statistic and Cochran's Q test. Data were pooled the standardized mean difference (SMD) effect size by the random-effect model.Results18 trials of 1681 citations were identified to be appropriate for the current meta-analysis. Findings random-effects model indicated that m-health interventions significantly decreased total- (SMD ?0.54; 95% CI, ?1.05, ?0.03) and LDL-cholesterol levels (SMD ?0.66; 95% CI, ?1.18, -0.15). M-health interventions had no significant effect on triglycerides (SMD ?0.14; 95% CI, ?0.56, 0.28) and HDL-cholesterol levels (SMD ?0.35; 95% CI, ?0.81, 0.11).ConclusionOverall, the current meta-analysis demonstrated that m-health interventions resulted in an improvement in total- and LDL-cholesterol, but did not affect triglycerides and HDL-cholesterol levels.     

Incidence of obesity,overweight and hypertension in children and adolescents in Ahvaz southwest of IRAN: Five-years study

ObjectiveThe purpose of this study was to investigate the incidence of obesity, overweight and hypertension in children and adolescents aged 10–15 in Ahvaz.MethodsThis is a epidemiologic study performed on 176 people aged 10–15 in Ahvaz. In 2009, 300 people underwent weight, height and blood pressure measurements. Five years later, the same people were reassessed for obesity, overweight and hypertension, of whom a total of 176 people agreed to repeat the procedure.ResultsThe study included 100 (57%) males and 76 (43%) females. Mean BMI was 22.1 ± 4.3 kg / m2 in year 2014, without any significant difference between the two sexes (P = 0.518). In the same year, the prevalence of obesity and overweight was 26 (14.8%) and 13 (7.4%), respectively. After 5years, BMI increased significantly (P < 0.001). Of the 150 norma participants with normal BMI in 2009, 15 (10%) and 6 (4%) became overweight and obese in 2014 respectively. The mean systolic and diastolic blood pressures increased significantly over 5 years P = 0.042 and P < 0.001.ConclusionsThis study shows an increase in mean BMI and mean systolic and diastolic blood pressures after 5 years among people aged 10–15 in Ahvaz.     

Nutrition transition – Pattern IV: Leads Bangladeshi youth to the increasing prevalence of overweight and obesity

Fast food and soft drinks consumption leading to excess calorie intake coupled with lack of acceptable physical activity has augmented the prevalence of overweight and obesity among the world population for the past few eras. A cross-sectional study was carried out among 475 youth selected by systematic random sampling attending in 27 established public and private universities and colleges of Bangladesh. The study was aimed to evaluate habitual facts associated with the prevalence of overweight and obesity among Bangladeshi youth. The rates of fast food consumption (once/week) are 50.6%, 43.7%, and 53.3% in overweight, pre-obese and obese-1 respondents accordingly and the rates of soft drinks consumption (4–6 times/week) are 40.5%, 59.2%, and 73.3% respectively for the same subjects. Moreover, approximately 40.8% of the youth went to fast food restaurants at least once per week and 27.2% went regularly (2 times/week). Youth having fast foods 2 times/week, consuming soft drinks 3–4 times/week were more likely to be obese. Besides, obesity epidemic was observed among those who have not the habit of doing physical exercise. This study provides evidence of increasing trend and threat to overweight and obesity for the Bangladeshi youth.