Obesity – ABC CARDIOL

IJCS

Letter to the Editor

Metabolic Challenges in The Semiarid Region: A Critical Analysis of Nutritional Transition and Early Cardiovascular Risk

Leonardo Alves Santos et al. Álvaro Eduardo Santos Oliveira Beatriz Vitória Carvalho Lordêlo Luis Antonio Cavalcanti Matias … Rodrigo Mendes Pedro Pereira Tenório

Dear Editor,

We had the opportunity to review the article entitled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia.” We would like to congratulate the authors for their initiative in investigating a pediatric cohort in a region marked by social and climatic vulnerability, frequently underrepresented in scientific literature, as well as for highlighting the relevance of addressing childhood obesity and arterial hypertension – two major cardiovascular risk factors with direct impact on future morbidity and mortality.

[…]

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Editorial

Gender differences in Body Adiposity and Endothelial Dysfunction in Overweight and Obese Individuals with Suboptimal Vitamin D Status

Marcelo Chiara Bertolami

The article by Faria et al. explored anthropometric indices, vascular and autonomic function in obese and overweight individuals with suboptimal vitamin D status.

Obesity has a significant impact on human health through multiple mechanisms. One potential mechanism involves the association between obesity and low vitamin D levels. The authors used advanced techniques to evaluate endothelial function in an overweight and obese population with suboptimal vitamin D levels.

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Original Article

Body Adiposity and Endothelial Dysfunction Assessed By Laser Speckle Contrast Imaging in Obese and Overweight Individuals With Suboptimal Vitamin D Status: Sex Differences

Adriana de Castro Carvalho Faria et al. Michelle Rabello Cunha Caroline Lyra Moreira Samanta Souza Mattos … Clara Castro Carvalho Oliveira Faria Leticia Castro Carvalho Oliveira Faria Wille Oigman Mario Fritsch Neves

Abstract

Background:

Low Vitamin D levels are prevalent in obesity and have been linked to adverse cardiovascular and metabolic outcomes.

Objective:

This cross-sectional study aimed to assess anthropometric indices, vascular, autonomic function in obese and overweight individuals with suboptimal vitamin D status.

Methods:

Participants of both sexes, 40-69 years, Body Mass Index (BMI) 25-40 kg/m², were divided into two groups above and under the median vitamin D level (22,6 ng/ml), named Suboptimal (SUB-D) and Lower (LOW-D) vitamin D, respectively. Vascular function was assessed using central hemodynamic parameters (Mobil-O-Graph®), endothelial function (microvascular reactivity; Laser Speckle Contrast Image system), and heart rate variability (Polar® monitor). The groups were compared using an unpaired Student’s t-test, and p-values < 0,05 were considered statistically significant.

Results:

The groups (n = 90) had similar ages and blood pressures. The LOW-D group had a higher body fat percentage (%BF; 29 ± 4 vs. 33 ± 3, p = 0.020) and glycated Hb (5.4 ± 0.4 vs. 5.8 ± 0.4, p = 0.029) in males. Females had higher Visceral Adiposity Index (VAI; 2.33 ± 0.86 vs. 3.32 ± 1.86, p = 0.008) and Lipid Accumulation Products (LAP; 39 ± 23 vs. 63 ± 40, p = 0.005). The LOW-D group showed a lower percentage increase in the area under the curve in post-occlusive reactive hyperemia (%AUC-PORH) (70 ± 30 vs. 55 ± 32%, p = 0.034). Females showed inverse correlation of vitamin D levels and VAI and LAP, and a positive correlation with %AUC-PORH.

Conclusions:

In obese and overweight individuals, lower vitamin D content was associated with higher levels of body adiposity in males. Furthermore, impaired metabolic functions and endothelial dysfunction were related to lower vitamin D levels in females, as in the central illustration.

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Guideline

iCARDIO Alliance Global Implementation Guidelines for the Management of Obesity 2025

Stefan D. Anker et al. Linong Ji Tammy Kindel Andrew J.S. Coats … Dike Ojji Adriana Puente Barragán Peter Rossing Shelley Zieroth Shaaf Ahmad Shariq Usman Geeta Appannah Alison L. Bailey Ahmed Bennis Andrea Brandao Javed Butler Melanie J Davies Lubomira Fabryova Yuan-Lin Guo Hidetaka Itoh Uday M. Jadhav Carel W. Le Roux Fausto J. Pinto Julio Rosenstock Banshi Saboo Hani Sabbour Mangesh Tiwaskar Karol E. Watson Kwang Wei Tham Fernando Stuardo Wyss Walter P. Abhayaratna William T. Abraham Wael Al Mahmeed Alessia Argirò John J. Atherton Danielle Belardo Raquel Campuzano Nandini Chatterjee Vijay Chopra Marc-André Cornier Sarah Davies Clemencia de Rueda Panadero Anastase Dzudie Ty J. Gluckman Muhammad Shahzeb Khan Kamlesh Khunti Yuri Lopatin Zhiyi Ma Okechukwu S. Ogah Abraham Oomman Emilio S. Peralta Lopez Ping Li Paul Poirier Julie Redfern Giuseppe M.C. Rosano Donna Ryan Amit Saraf Sameh Shaheen Subodh Verma Stephan von Haehling Yuhui Zhang Martha Gulati Naveed Sattar Jose Luis Zamorano

Abstract

There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and – most importantly – also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such “economic adjustment” recommendations aim to guide situations when “Resources are somewhat limited” or when “Resources are severely limited”. Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

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Editorial

The Relationship Between Obesity and the Risk of Systemic Arterial Hypertension in Children and Adolescents: Lessons Learned

John Jairo Araujo

One out of five children around the world is overweight or obese. This is shown in the meta-analysis published by Zhang X et al. in 2024, which included 2,033 studies from 154 different countries or regions. Although the prevalence of childhood obesity varies between global regions, it is evident that its incidence is growing significantly. According to the latest United Nations International Children’s Emergency Fund (UNICEF) and World Bank estimates, 33.6% of children and adolescents 5-19 years old are affected by overweight or obesity, as are 8% of children under the age of five. Recently, Muyulema SL et al. published the results of global childhood overweight and obesity trends over the last 20 years. In this study, they analyzed 194 countries around the world, showing that the global prevalence of childhood overweight and obesity increased from 5.4% to 5.7% between 2000 and 2022.

Inflammation, Metabolic Syndrome and Systemic Hypertension: “a dangerous and synergistic triad”: Metabolic Syndrome (MS) has been well defined in adults, and includes various conditions like Systemic Arterial Hypertension (SAH), elevated fasting blood sugar levels (greater than 100 mg/dl) or type 2 diabetes mellitus, low HDL cholesterol levels (less than 40 mg/dl in men or 50 mg/dl in women), high triglyceride concentrations (greater than 150 mg/dl), and a waist circumference greater than 101 cm (men) or 90 cm (women). It is not clearly defined in children, due to the imprecision of the various factors that compose it and the changes in different stages of life. However, risk factors like obesity, increased waist circumference (increased visceral fat), insulin resistance, and, in certain cases, lipid profile abnormalities, are compatible with MS, especially in children over the age of 10.

[…]

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Original Article

Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia

Andressa Lopes et al. Ana Luisa Vaz Valois Hanna Louise de Almeida Lisboa Alexvon Nunes Gomes … Renata Lago Camilla Almeida Menezes Ana Marice Teixeira Ladeia

Abstract

Background:

Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential.

Objective:

To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia.

Methods:

This study is part of a project evaluating the impact of a school meal intervention on the health of children and adolescents in Bahia’s backlands. A subset of children aged five to ten from public schools in both rural and urban areas of four cities in Bahia’s backlands was selected through random and proportional sampling. The participants had their weight, height, waist circumference and BP measured using standardized protocols. The Body Mass Index (BMI) was expressed as a z-score to determine nutritional status. The Student’s t-test and Chi-square tests were used, with 5% statistical significance.

Results:

The sample consisted of 461 students, 264 (57.3%) from urban areas and 238 (51.6%) males. The prevalence of overweight was 27.9%, and that of increased waist circumference was 7.4%. High BP or hypertension had a prevalence of 8%. A significant difference (p = 0.049) was observed between rural and urban areas in relation to the increased waist circumference.

Conclusion:

The research revealed a high frequency of overweight, increased waist circumference and systemic BP in students, mainly those from urban areas.

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Original Article

Body Profile Impact on Blood Pressure and Lipid Profile in Rural and Urban Schoolchildren of a Brazilian Semiarid Region in The State of Bahia

Lívia Assis Mendonça et al. Alexvon Gomes Renata Lago Camilla Menezes … Sérgio Roberto Lemos de Carvalho Ana Marice Teixeira Ladeia

Abstract

Background:

The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence.

Objective:

To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence.

Methods:

Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student’s t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544).

Results:

Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables.

Conclusion:

Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

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Original Article

Correlation of Diagnostic Components of Metabolic Syndrome with Electrocardiographic and Echocardiographic Alterations in Patients with Obesity

Alan Souza da Luz et al. João Gabriel da Costa Ramos Carolina Heitmann Mares Azevedo Ribeiro Roberto Márcio de Oliveira Júnior … Antônio Carmo da Costa Siqueira Neto Ralf Cardoso Mudesto Oliveira

Abstract

Introduction:

Metabolic syndrome (MS) and obesity are risk factors for cardiovascular diseases (CVD). However, the development of cardiovascular pathologies in obese individuals without MS is being investigated.

Objective:

To investigate whether there are similar electrocardiographic (ECG) and echocardiographic changes in individuals with obesity with and without MS.

Methodology:

A retrospective, descriptive cross-sectional study was carried out with obese patients at a university hospital in Belém, Pará, Brazil. Anthropometric, laboratory, ECG and echocardiographic data were evaluated in both populations. The chi-square test was used to describe the relationship between variables among groups; hypothesis tests with p < 0.05 were considered statistically significant values.

Results:

The study evaluated 100 individuals with obesity, 60 of whom had MS. The average age was 54 years, and the female sex was prevalent. Systolic blood pressure, HDL, and waist circumference were altered in both groups. Systemic arterial hypertension and low HDL demonstrated 4.27 times and 3.32 times greater likelihood of presenting changes in the ECG and echocardiogram for both groups. On the ECG, diffuse changes in ventricular repolarization were observed in both groups. On echocardiography, left ventricular diastolic dysfunction and left ventricular hypertrophy were present in both populations studied.

Conclusion:

Obese individuals without MS present a similar risk, requiring adequate attention to their cardiac health.

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Original Article

Association of Dietary Inflammatory Potential in Metabolically Healthy and Metabolically Unhealthy Obese Individuals

Lara Ribeiro Pinto et al. Luciana Nicolau Aranha Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira Glorimar Rosa

Abstract

Introduction:

Currently, two types of phenotypes have been recognized in individuals who are obese. Among the factors related to lifestyle, diet has a relevant influence, although there is no consensus regarding the role of diet in metabolic phenotypes; furthermore, diet is a strong moderator of chronic systemic inflammation.

Objective:

Investigate dietary inflammatory potential between metabolic phenotypes and to compare the differences between anti-inflammatory and pro-inflammatory diets in individuals with the same phenotype.

Methods:

This is a cross-sectional observational study that utilized the database of 533 individuals divided into 4 groups, according to metabolic phenotype and dietary inflammatory characteristic. Sociodemographic, clinical, anthropometric and biochemical characteristics were evaluated and the inflammatory index of the diet was calculated.

Results:

The mean Dietary Inflammatory index (DII) of the total sample was 0.974±1.02, with a maximum of 4.34 and a minimum of −1.74. In the metabolically unhealthy groups, we found a statistical difference in relation to systolic blood pressure when comparing the anti-inflammatory [median 120 (110.0-130.0)] and pro-inflammatory diets [median 130 (120.0-140.0); p = 0.022], and mean isoprostane concentrations were lower in the metabolically healthy group with anti-inflammatory diet. In regression analysis, the only variable that demonstrated a higher risk of alterations in all groups when compared to the metabolically healthy and anti-inflammatory group were isoprostane concentrations.

Conclusion:

We are able to conclude that an anti-inflammatory diet is associated with lower oxidative stress in metabolically healthy obese, and a pro-inflammatory diet is associated with higher systolic blood pressure values.

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Original Article

Effect of Hypoenergetic Diet Combined With Pumpkin Seed Flour Consumption on Obese Women

Anna Paula Soares de Carvalho et al. Luciana Nicolau Aranha Larissa Almenara Soares Ronir Raggio Luiz … José Firmino Nogueira Neto Gláucia Maria Moraes de Oliveira Glorimar Rosa

Abstract

Background

Dietary treatment containing fiber-rich foods may contribute to lowering weight in obese women.

Objective

To investigate the effect of a hypoenergetic diet combined with pumpkin seed flour (PSF) consumption on diet quality, anthropometric indices, and glucose and lipid metabolism in obese women.

Methods

We conducted a randomized, double-blind, placebo-controlled, 90-day clinical trial with obese women, distributed into the following two groups: hypoenergetic diet + placebo (PG) and hypoenergetic diet + pumpkin seed flour (PSFG). A total of 100 participants were included in the PSFG (n = 47) and PG (n = 53). We evaluated neck circumference (NC); waist to height ratio; conicity index; fat mass (FM); lipid profile; blood concentrations of glucose and insulin; homeostatic model assessment for insulin resistance (HOMA-IR); quantitative insulin sensitivity check index (QUICKI); and blood pressure at baseline, 30, 60, and 90 days. Dietary analysis was determined by differences between diet quality indices before and after prescribing the experimental diet. Chi-squared, Student’s t-tests and analysis for repeated measures were used, and values were considered significant at p < 0.05.

Results

The dietary pattern improved after 90 days in both groups. The PSFG presented lower NC (p < 0.001), FM (p = 0.010), triglycerides (TG) (p = 0.025), insulin (p = 0.003), and HOMA-IR (p = 0.018). The PG presented a lower diastolic blood pressure (p = 0.004) and low-density lipoprotein cholesterol (LDL-c) (p = 0.056).

Conclusion

A hypoenergetic diet combined with PSF consumption contributes to lowering NC, FM, HOMA-IR, TG, and insulin concentrations.

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Original Article

Food Consumption and Health Outcomes in Women During the COVID-19 Pandemic

Mariana Barbosa Lopes et al. Luciana Nicolau Aranha Lara Ribeiro Pinto Paula Critina Moreira dos Santos Lino … Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira Glorimar Rosa

Abstract

Background

The COVID-19 pandemic has changed food consumption.

Objective

Evaluate the association between metabolic phenotypes, changes in food consumption during the pandemic, and health outcomes in obese women.

Methods

Cross-sectional observational study including 491 women without previous diagnosis of chronic diseases, evaluated according to metabolic phenotype. During the pandemic, a subsample was re-evaluated by online questionnaires via Google Forms. Analyzed anthropometric, biochemical, and dietary data as well as health outcomes (coronary artery disease, type 2 diabetes, hypertension, dyslipidemia or death). Information on mortality was collected from the Internal Affairs Office of the State of Rio de Janeiro and the Health Department of the State of Rio de Janeiro. Statistical analysis was performed using the statistical program SPSS 21, with Mann-Whitney test, Pearson’s chi-squared, Spearman correlation, and binary logistic regression, at a significance level of 5%.

Results

The anthropometric, glucose, and lipid profiles showed significant differences between the metabolically healthy and metabolically unhealthy groups (p = 0.00). Before the pandemic, women in the metabolically unhealthy group had higher dietary intakes of lipids (p = 0.01), saturated fat (p = 0.01) and sodium (p = 0.04), during the pandemic, they consumed more energy (p = 0.04), lipids (p = 0.02), saturated fat (p = 0.02), proteins (p = 0.03) and sodium from ultra-processed foods (p = 0.03). Consequently, health outcomes were more prevalent in the metabolically unhealthy group (p = 0.00).

Conclusion

Observed that metabolically healthy women had qualitatively better food intake and fewer health outcomes throughout the study.

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Editorial

Weight Excess: The Great Villain in the Development of Hypertension in Adolescents

Erika Maria Gonçalves Campana et al. Maria Eliane Campos Magalhães Andréa Araujo Brandão

The relationship between arterial hypertension (AH) and excess weight in young populations is well established. This association involves several conditions including hyperinsulinemia, altered adipokine profile, elevated markers of subclinical inflammation, and inadequate habits, including physical inactivity.^–

In a study^– conducted in the city of Rio de Janeiro, Brazil, an increased body mass index in adolescents was correlated with a higher prevalence of elevated blood pressure (BP) and higher risk of developing AH at young adult age. From a longitudinal perspective, an interesting aspect in the assessment of cardiovascular risk factors is the tracking effect, in which children and adolescents with altered clinical and metabolic parameters (BP, body mass index and cholesterol levels) are likely to maintain an abnormal profile of these variables throughout life and become adults at increased cardiovascular risk.^– This fact highlights the continuous, unfavorable impact of persistent obesity from childhood to adulthood on cardiovascular risk factors.

[…]

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Editorial

Does Gluten Decrease (or Increase) Metabolic Syndrome Risk?

Sérgio Girão Barroso et al. Caroline Luiza Codonho Castro

Overall, weight gain and obesity are consequences of chronic energy imbalance, in which energy intake exceeds energy expenditure and leads to excessive energy (fat) storage. If gluten is a causative factor for weight gain, the underlying mechanisms remain unknown, and studies on non-coeliac individuals are scarce. Over recent years, gluten free diet (GFD) has become popular as books and social media have suggested that gluten consumption causes overweight and metabolic syndrome (MS) parameters. However, data supporting such statement are often feeble and questionable.

Firstly, due to its gluten content, wheat has likely been one of the most maligned foods over the past years. Nonetheless, whole wheat products are held as a good source of indigestible dietary fiber and other bioactive components. Avoiding wheat consumption could thus be associated with decreasing fiber and other beneficial constituents in the diet, and increasing glycemic index. Currently, three conditions require treatment with GFD: wheat allergy, non-coeliac gluten-sensitivity, and coeliac disease (CD).^,

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Editorial

Neuropeptides Y and Other Promising Biomarkers in Acute Coronary Syndrome

Fernanda A. Andrade et al. Leonardo Carvalho Pedro Gabriel Melo de Barros Silva

Neuropeptide Y (NPY) is a very common neurotransmitter with 36 amino acids that acts as a stimulator of angiogenesis, inflammation and adipogenesis through the NPY2 receptor. The description of high plasma concentrations of NPY in acute coronary syndrome (ACS) and left ventricular dysfunction and its close relationship with the sympathetic nervous system reinforces the possibility of a new prognostic biomarker for risk stratification.^,

In recent years, changes in the NPY signalling pathway have been related to ACS. For example, the NPYc.20T>C mutation is associated with increased serum lipid levels and consequent increase in the risk of ACS, stroke, hypertension, and obesity.^, The NPYc.-485T>C variant has been linked to the development of early atherosclerosis and stroke, and possibly to insulin resistance reduction and development of type 2 diabetes mellitus.^–

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Original Article

Cardiovascular Risk Factors in Children and Adolescents with Fontan Circulation

Sandra Mari Barbiero et al. Rafael B. Carloto Danielly Steffen Pereira Gabriela C. Schwantes … Marcela Menuci Guimarães Maíra Ribas Goulart Daniela Schneid Schuh Lucia Campos Pellanda

Abstract

Background:

Long-term outcomes of patients with Fontan circulation are uncertain regarding the prevalence and role of risk factors (RFs) such as increased body mass index (BMI), arterial hypertension, and hypercholesterolemia.

Objectives:

To describe the prevalence of RFs in patients with univentricular heart, with variable follow-up times.

Methods:

This mixed cohort study was performed with 66 patients, who underwent blood count, fasting blood glucose, C-reactive protein (CRP), and lipid profile tests; systolic/diastolic blood pressure (SBP/DBP) measurements; and anthropometric and sociodemographic data collection. Cardiovascular RFs among first-degree relatives and physical activity habits were also assessed. Prevalence was described using proportions, with a 95% confidence interval. Continuous variables (height, weight, age, SBP, DBP) were described as means and standard deviations (m±SD). Associations between RFs were assessed using chi-squared or Fisher’s exact tests. Spearman’s correlation was used for analyzing CRP and the presence of 2 or more RFs. The Shapiro-Wilk test was used to check for data normality. Statistical significance considered p<0.05.

Results:

In our population, 19.7% were overweight, mean SBP was 89.44±37.4, and mean DBP was 60.0±26.08. The most prevalent diseases in the interviewees’ families were systemic arterial hypertension (30.3%), obesity (16.7%), and 2 or more cardiovascular RFs among first-degree relatives (13.8%). We observed a trend towards significance between the presence of 2 familial RFs and overweight, as well as a risk profile for cardiovascular disease. There was an association between the BMI percentile, the presence of 2 or more RFs (p<0.05), and CRP (p<0.01).

Conclusions:

Overweight is common in patients with univentricular heart, being related to more than 2 cardiovascular RFs among first-degree relatives; physical inactivity and changes in lipid profiles are also frequent.

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Review Article

Does a Gluten-free Diet Improve Metabolic Syndrome Parameters? A Systematic Review

Luciana Gonçalves Orange et al. Maria Izabel Siqueira de Andrade Cybelle Rolim Lima Keila Fernandes Dourado … Thayná Menezes Santos Marina Moraes Petribu Priscilla Regia de Andrade Calaça Silvia Alves Silva

Abstract

To review scientific evidence on the effects of a gluten-free diet on body composition and improvement of clinical and biochemical parameters of metabolic syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes – PRISMA guidelines were followed. A literature search was performed in the PubMed, ScienceDirect, Trip Database, Bireme and Scielo databases, without language restriction, until March 2021. The terms “gluten-free diet”, “obesity”, “metabolic syndrome”, and “weight loss”, and Boolean operators (AND/OR) were used. The clinical hypothesis was structured according to the acronym PICOT. Randomized clinical trials with adult and elderly humans without a diagnosis of celiac disease, consuming a gluten-free diet, evaluating associations of the effects of this diet on weight loss and metabolic syndrome components were considered eligible. To assess the risk of bias, the RoB2 was used. A total of 3,198 articles were identified and, after the screening and evaluation of pre-defined eligibility criteria, four studies were included in the qualitative analysis. Weight loss was not associated with a gluten-free diet. However, individuals under a gluten-free diet had lower mean waist circumference, fat percentage (-2.3%) and serum triglyceride levels. The impact of a gluten-free diet on metabolic syndrome parameters is still controversial. In individuals without gluten sensitivity or celiac disease, the consumption of a gluten-free diet appears to provide no nutritional benefit.

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Original Article

Family History of Hypertension: Impact on Blood Pressure, Anthropometric Measurements and Physical Activity Level in Schoolchildren

Tatiana Affornali Tozo et al. Beatriz Oliveira Pereira Francisco José de Menezes Junior Cristianne Morgado Montenegro … Carla Marisa Maia Moreira Neiva Leite

Abstract

Background:

A family history of arterial hypertension (AH), combined with environmental risk factors, is directly related to the development of AH.

Objectives:

To evaluate the frequency of AH, anthropometric indicators and level of physical activity and their association with a family history (FH) of AH in school children.

Methods:

Cross-sectional study with 118 students, aged between 11 and 17 years, of both sexes. Waist circumference (WC), weight, height, level of physical activity and FH of HA were collected. Body mass index z score (BMI-z) and waist-to-height ratio (WHtR) were calculated. Binary logistic regression model was used to verify the chance risk, with significance p <0.05.

Results:

Of the 118 parents who answered the questionnaire, 34.7% had a positive FH of AH. Girls with a positive FH had higher means of WC (p= 0,004), BMI (p=0,020), and systolic blood pressure (SBP) (p=0,006) than boys, and a higher risk of being overweight (OR=4,48; 95%CI:1,55–12,94), and having elevated WHtR (OR=5.98; 95%CI:1.66– 21.47) and SBP (OR=3,07; 95%CI:1,03–9,13) than girls without a FH, but they practice more vigorours moderate physical activity (MVPA) (p=0,039). On the other hand, no differences in these parameters were observed between boys with and without a FM of AH.

Conclusion:

Overweight and a FH of hypertension were associated with an increased risk for AH in girls. This was not observed among boys, perhaps due to more active lifestyle.

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Viewpoint

Physical Activity, Obesity, and COVID-19: What can we Expect from his Relationship?

Ciro Oliveira Queiroz et al. Ariani França Conceição Paulo Rodrigo Santos Aristides Leandro Silva Alves Rogério Tosta Almeida

The COVID-19 pandemic is a public health problem, whose first cases were found in Wuhan, China, in December, 2019, and which is currently present around the world. COVID-19 is caused by the new coronavirus (SARS-CoV-2), which shows a high potential of contamination. Its transmission occurs through droplets during unprotected proximity with an infected person and contact with contaminated environmental surfaces, which are the main systemic and respiratory symptoms.^,

To date, there is no pharmacological treatment that has proven to be effective, or a vaccine for the prevention or treatment of COVID-19. Thus, a non-pharmacological strategy of public health, which has shown effectiveness in the exponential control of the disease, is social distancing, which encompasses the isolation of cases, quarantine of contacts, and the voluntary practice of not going to crowed places. These measures have demonstrated that they can reduce mortality rates during the pandemic, and they have helped in governmental decision-making.^,

[…]

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Original Article

Hypertension and Different Levels of Body Mass Index and Cardiorespiratory Fitness Amongst Adolescents

Cleiton Bertollo et al. Claúdia Daniela Barbian Letícia de Borba Schneiders João Francisco de Castro Silveira … Bruna Dahmer Vogt Elza Daniel de Mello Leandro Tibiriçá Burgos James Philip Hobkirk Cézane Priscila Reuter

Abstract

Background

Hypertension is an increasingly common problem in adolescents; amongst the associated factors, physical inactivity and obesity are increasing the risk of developing cardiovascular diseases.

Objective

To verify whether there is an association between higher blood pressure levels amongst adolescents with the relationship between different levels of body mass index (BMI) and cardiorespiratory fitness (CRF).

Method

Cross-sectional study consisting of 860 adolescents. Higher blood pressure (BP) was considered as borderline and hypertension as the classification. BMI was categorized as low-normal weight and overweight-obesity. The CRF was assessed by a nine-minute run/walk test and classified into low or appropriate levels (less and more favorable to health, respectively). Later, BMI and CRF were grouped into one categorical variable: (I) low/normal weight and appropriate CRF levels; (II) low/normal weight and low CRF levels; (III) overweight/obesity and appropriate CRF levels; and (IV) overweight/obesity and low CRF levels. Data were analyzed using Poisson regression, through the prevalence ratio (PR) and 95% confidence intervals (CI). The p-values of p <0.05 were considered significant.

Results

Adolescents with overweight/obesity and low CRF levels had a 22% higher BP prevalence. Moreover, children with overweight/obesity, but with appropriate CRF levels, have a 15% higher BP prevalence.

Conclusion

Adolescents with overweight/obesity had a higher prevalence of BP, regardless of CRF levels. It is suggested that maintaining normal BMI is a protective factor for less favorable BP.

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Original Article

Cardiac Remodeling in Obesity-Resistance Model is not Related to Collagen I and III Protein Expression

Scarlet Marques de Oliveira et al. Jéssica Leite Garcia Danielle Fernandes Vileigas Dijon Henrique Salomé de Campos … Fabiane Valentini Francisqueti-Ferron Artur Junio Togneri Ferron Danielle Cristina Tomaz da Silva-Bertani Carlos Roberto Padovani Camila Renata Corrêa Antonio Carlos Cicogna

Abstract

Background:

As some individuals present resistance to obesity development, experiments have been trying to understand their susceptibility to cardiometabolic diseases.

Objetive:

To evaluate if the cardiac remodeling was related to collagen protein expression change.

Methods:

Male Wistar rats were randomized into two experimental groups: control diet (CD, n=15) or high-fat diet (HFD, n=15) for 30 weeks. Rats fed with HFD were ranked based on their adiposity indexes and classified as obese (Ob, n = 8) or obesity-resistant (ROb, n = 6). Rats that failed to present the normal characteristic of the control group while fed with CD were excluded (Control, n = 8). Nutritional profile, comorbidities (dyslipidemia, hypertension, glucose metabolism, hyperleptinemia), cardiac remodeling, and collagen protein expression were evaluated. The groups were compared by One-Way ANOVA, together the Tukey post hoc test, with p<0.05 considered significant.

Results:

The Ob rats presented an increased adiposity index when compared to C and ROb. Both groups Ob and ROb presented increased low-density lipoprotein (LDL), insulin, homeostatic model assessment of insulin resistance (HOMA- IR) and systolic blood pressure (SBP), and low high-density lipoprotein (HDL) levels when compared to the control group. The levels of triglycerides, non-esterified fatty acid (NEFA), and leptin were lower in ROb as compared to Ob, but higher than the control group. The Ob and ROb groups presented cardiac remodeling, evidenced by echocardiographic and post-mortem analysis. The collagen protein expression did not differ among the groups.

Conclusion:

The ROb animals present cardiac remodeling that is not related to collagen type I and III protein expression change.

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Editorial

Cardiovascular Risk in Women from a Quilombo Settlement: The Effect of Aggregated Vulnerabilities

Deborah Carvalho Malta et al. Luisa Campos Caldeira Brant

Cardiovascular risk (CVR) is a field of great relevance with a growing number of studies throughout the country due to the magnitude of cardiovascular diseases (CVD), which have caused nearly 18 million deaths in 2016 and represent 31% of worldwide deaths.^– In Brazil, CVD also lead the mortality and disability-adjusted life years (DALYs) rates,^4.5 with negative effects on the quality of life of individuals, family members, and societies.^3.5 It is noteworthy that CVD has an unequal effect on populations, with greater morbidity and mortality among low-income and least educated individuals.6 In this context, it is important to identify the modifiable risk factors (RF) associated with CVD, such as behavioral (tobacco, alcohol, unhealthy diet, sedentarism) and metabolic RF (obesity, diabetes, hypertension, dyslipidemia); given that the risk of death from CVD attributable to metabolic RF is 74%, revealing great potential for prevention.^,

CVR scores are important because evidence has shown that when RF are aggregated, they have synergistic effects on the risk of major adverse cardiovascular events (MACE).^, As such, CVR scores identify high-priority individuals for specific primary preventive interventions against MACE, making them cost-effective measures that are useful in primary care.^,^– Beyond the incentive for a healthy lifestyle, individuals with higher CVR should be offered statin prescriptions and be evaluated for hypertension treatment at a lower threshold. A meta-analysis showed that statins can prevent 23% (relative risk [RR] 0.77 95% confidence interval [CI] 0.71–0.84) of MACE. However, for primary prevention this benefit is positively correlated with CVR and non-high-density lipoprotein (HDL) cholesterol values.

[…]

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Original Article

Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women

Ricardo Quental Coutinho et al. Ulisses Ramos Montarroyos Isly Maria Lucena de Barros Maria José Bezerra Guimarães … Ana Paula Dornelas Leão Laura Olinda Bregieiro Fernandes Costa Ana Kelley de Lima Medeiros Maria de Fátima Monteiro Moacir de Novaes Lima Ferreira William Azem Chalela Rodrigo Pinto Pedrosa

Abstract

Background

Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable.

Objective

To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers.

Methods

This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05).

Results

According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity 0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score.

Conclusion

Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.

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Original Article

Lifestyle Intervention in Reducing Cardiometabolic Risk Factors in Students with Dyslipidemia and Abdominal Obesity: A Randomized Study

Heloisa Pamplona-Cunha et al. Nilton Rosini Roberta Caetano Marcos José Machado Edson Luiz da Silva

Abstract

Background

The long incubation periods of cardiovascular diseases offer opportunities for controlling risk factors. In addition, preventive interventions in childhood are more likely to succeed because lifestyle habits become ingrained as they are repeated.

Objective

To investigate the effects of recreational physical activities, in combination or not with a qualitative nutritional counseling, in cardiometabolic risk factors of students with dyslipidemia and abdominal obesity.

Methods

Students (8-14 years old) were randomly divided into three groups (n=23 each): i ) Control; ii ) PANC, students undergoing Physical Activity and Nutritional Counseling, and iii ) PA, students submitted to Physical Activity, only. Blood samples (12-h fasting) were collected for biochemical analysis and anthropometric markers were also assessed. Two-Way RM-ANOVA and Holm-Sidak’s test, and Friedman ANOVA on Ranks and Dunn’s test were applied. P ≤ 0.05 was considered significant. Effect sizes were evaluated by Hedges’ g and Cliff’s δ for normal and non-Gaussian data, respectively.

Results

Compared to the control group and to baseline values, both interventions caused significant average reductions in total cholesterol (11%; p <0.001), LDL-c (19%; p=0.002), and non-HDL-c (19%; p=0.003). Furthermore, students in the PANC group also experienced a significant decrease in body fat compared to baseline (p=0.005) and to control (5.2%; g=0.541).

Conclusions

The proposed strategies were effective to reduce cardiometabolic risk factors in children and adolescents. The low cost of these interventions allows the implementation of health care programs in schools to improve the students’ quality of life.

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Original Article

Reference Equation for the Six-Minute Walk Test in Brazilian Patients with Obesity

José Carlos do Vale Quaresma et al. João Regis Ivar Carneiro Norma Ferreira Marschhausen Gustavo Gavina da Cruz … José Fernandes Filho Ronir Raggio Luiz

Abstract

Background:

Obesity has repercussions on functional capacity (FC). The six-minute walk test (6MWT) is a useful tool for assessing submaximal FC, and the distance reached at 6 minutes of walking (D6MW) is a relevant prognostic marker.

Objective:

This paper aims to establish a reference equation for the distance predicted in 6MWT in obese Brazilian subjects.

Methods:

This study included 460 patients (306 women), with a body mass index (BMI) > 30 kg/m², 71% (328) of whom presented a grade III obesity (BMI ≥ 40 Kg/m²) and were evaluated with 6MWT. Heart rate, blood pressure, oxygen saturation and Borg scale perception of effort were recorded before and after the 6MWT. For statistical analysis, Kolmogorov-Smirnov tests, an unpaired T-Test, Pearson’s correlation, and multiple linear regression were used, together with a significance level set at p<0.05.

Results:

Gender, age, and BMI were significantly correlated with D6MW and were identified by multiple linear regression as the best predictors of the D6MW. Together, they explain 48.7% of the D6MW variance for obese Brazilian subjects. Based on these findings, an equation was proposed – D6MW = 930.138 + (27.130 x Genderfemales = 0; males = 1) − (5.550 x BMI kg/m²) − (4.442 x Age years). When the average of the D6MW obtained with the above equation was compared to the average calculated with the equations described in medical literature for healthy and obese individuals, the latter tended to overestimate the D6MW.

Conclusion:

The proposed reference equation exhibited better assessment of FC in obese Brazilian patients, providing proper subsidies for the follow up ofinterventions in this population..

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