Adult obesity in different countries: an analysis via beta regression models

Factores de riesgo para el desarrollo de infección del sitio quirúrgico en cirugía bariátrica: una revisión integradora

Resumen Objetivo: evaluar las evidencias sobre los factores de riesgo para el desarrollo de infección de sitio quirúrgico en cirugía bariátrica. Método: revisión integradora. La búsqueda de estudios primarios se realizó en cuatro bases de datos. La muestra estuvo compuesta por 11 investigaciones. La calidad metodológica de los estudios incluidos se evaluó mediante herramientas propuestas por el Joanna Briggs Institute. El análisis y la síntesis de los datos se realizaron de manera descriptiva. Resultados: las tasas de infección del sitio quirúrgico oscilaron entre 0,4% y 7,6%, considerando los resultados de los estudios primarios, en los que los pacientes fueron sometidos a cirugía mediante laparoscopia. En investigaciones con participantes que se sometieron a procedimientos quirúrgicos con diferentes enfoques (abierto, laparoscópico o robótico), las tasas de infección oscilaron entre el 0,9 % y el 12 %. En cuanto a los factores de riesgo para el desarrollo de este tipo de infección, se destacan la profilaxis antibiótica, el sexo femenino, el Índice de Masa Corporal elevado y la hiperglucemia perioperatoria. Conclusión: la realización de la revisión generó un cuerpo de evidencia que refuerza la importancia de implementar medidas efectivas para la prevención y el control de la infección de sitio quirúrgico, por parte de los profesionales de la salud, después de la cirugía bariátrica, promoviendo la mejora de la atención y la seguridad del paciente en el período perioperatorio.

Fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica: revisão integrativa

Resumo Objetivo: avaliar as evidências sobre os fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica. Método: revisão integrativa. A busca dos estudos primários foi realizada em quatro bases de dados. A amostra foi composta por 11 pesquisas. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. A análise e a síntese dos dados foram realizadas de maneira descritiva. Resultados: as taxas de infecção de sítio cirúrgico variaram de 0,4% até 7,6%, considerando os resultados dos estudos primários, cujos pacientes foram submetidos à cirurgia por via laparoscópica. Nas pesquisas com os participantes submetidos aos procedimentos cirúrgicos com diferentes abordagens (aberta, via laparoscópica ou robótica), as taxas de infecção variaram de 0,9% até 12%. Com relação aos fatores de risco para o desenvolvimento deste tipo de infecção, ressaltam-se antibioticoprofilaxia, sexo feminino, Índice de Massa Corporal elevado e hiperglicemia perioperatória. Conclusão: a condução da revisão gerou corpo de evidências que reforça a importância na implementação de medidas efetivas para prevenção e controle de infecção de sítio cirúrgico pelos profissionais de saúde após cirurgia bariátrica, promovendo a melhoria da assistência e da segurança do paciente no perioperatório.

The degree of food processing can influence serum fatty acid and lipid profiles in women with severe obesity

Background

The increase in the prevalence of obesity is associated with the increase in the consumption of ultra-processed foods and may be related to the increase in the disorders involving metabolism and the transport and storage of fatty acids.

Objective

To evaluate the effect of processed food consumption according to the degree of processing on the serum fatty acid levels and lipid profile of women with severe obesity.

Methods

This was a cross-sectional study. Data were collected from anthropometric assessments, the food frequency questionnaire (FFQ), and blood tests for lipidogram studies and serum fatty acid measurements. The foods consumed were identified through the FFQ and classified according to the degree of processing based on the NOVA rating, and the frequencies of consumption were transformed into scores, as proposed by Fornés methodology. Data were analyzed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%.

Results

This study included 44 women with a mean age of 40.59 years and mean body mass index of 48.61 kg/m2. An inverse association was observed between the consumption of unprocessed and the occurrence of hypertriglyceridemia (p = 0.021) and levels of triglycerides (p = 0.047), total cholesterol (p = 0.030), and very low-density lipoprotein-cholesterol (p = 0.039). The consumption of processed foods was positively associated with the presence of hypertriglyceridemia (p = 0.044) and omega 6/3 ratio (p = 0.001) and negatively associated with total omega 3 levels (p = 0.011). The consumption of processed foods was positively associated with total cholesterol (p = 0.041) and negatively associated with the omega 3/6 ratio (p = 0.001). A negative correlation was found between the average consumption of ultra-processed foods (at least once a week) and serum level of high-density lipoprotein (p = 0.035).

Conclusion

The consumption of processed and ultra-processed foods was associated with unfavorable lipid profiles and fatty acid levels in women with severe obesity. These results emphasize the importance of promoting the consumption of unprocessed food to mitigate metabolic disorders linked to processed food intake.

Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature

OBJECTIVE

to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery.

METHOD

integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner.

RESULTS

surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted.

CONCLUSION

conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

Factors associated with bariatric surgery rates in federative units in Brazil

OBJECTIVE

To analyze the socioeconomic, demographic and health management factors associated with bariatric surgery rates performed by the Brazilian Unified Health System (SUS) in the federative units in Brazil.

METHODS

Description and analysis of bariatric surgeries rates (per 100,000 inhabitants) performed by SUS in adults from 18 to 65 years old, in the 27 federative units of Brazil, between 2008 and 2018; thus, the econometric methodology of count panel with negative binomial distribution (population-averaged, fixed effects and random effects) was used. Socioeconomic and demographic factors were also investigated, considering the real gross domestic product per capita, the average years of study of adults and life expectancy at birth, and those of health management, given the primary health care coverage, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care to patients with obesity in the SUS.

RESULTS

In regional terms, the performance of public bariatric surgeries in Brazil over the period analyzed suffered a great disparity; the procedures happen mostly in the South and Southeast regions, and scarcely in the North region. Moreover, we found a positive relationship between the rate of bariatric surgeries and life expectancy, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care; however, the average number of years of adult study and coverage of primary health care is a negative association regarding real gross domestic product per capita.

CONCLUSION

In the period analyzed, the investigated factors explained the rate of bariatric surgeries. Therefore, to train specialized health professionals, the accreditation of hospitals according to the legal framework, preventive actions of primary care, and socioeconomic and demographic factors, conditioning for the offer of surgical treatment by the SUS were crucial. Thus, these are all relevant factors for the formulation of public policies in this area.

Relationship of lipid metabolism disorders with the development of fatal and non-fatal cardiovascular events in residents of the Chui region of the Kyrgyz Republic of varying sex and ethnicity

Aim. To study the relationship of lipid metabolism disorders (overweight, general and abdominal obesity (AO)) with the development of fatal and non-fatal cardiovascular events (CVEs) among residents of the Chui region of the Kyrgyz Republic of varying sex and ethnicity.

Material and methods. This study was performed as part of the international prospective epidemiological project “Interepid”. The total follow-up period was 7 years. Vital status at the end of the follow-up period was monitored in 1096 respondents from 1341 initial cohorts. Response rate was 82,1%. As an endpoint, the analysis included cases of fatal and non-fatal CVEs. The prevalence of events was assessed by survival analysis methods (Cox proportional hazard regression model, parametric survival models, Kaplan-Meier estimator).

Results. In total, 181 (16,44%) cases of fatal and non-fatal CVEs were recorded during the follow-up period. In individuals with normal body weight, the incidence of CVEs was 10%. In overweight persons, it increased and reached 17,99% (p<0,001), while in those with obesity — 24,5% (p<0.0001). An increase in CVE rate with an increase in body mass index was recorded in all analyzed subgroups (men, women, Russians, Kyrgyz). Cox regression model with a logistic regression analysis made it possible to confirm the independent role of general and AO in the development of fatal and non-fatal cardiac and cerebral accidents in both ethnic groups in women, but not in men.

Conclusion. An increase in body mass index >25 kg/m2 and the presence of AO are independent risk factors for fatal and non-fatal CVEs in the analyzed cohort of residents of the Chui region in women (but not men) of both ethnic groups.

Age and gender aspects of the association of generalized obesity with development of fatal and nonfatal cardiovascular events (results of the prospective cohort study “Interepepid”)

Background. Currently, obesity has become one of the most important medical and social problems in the world due to its high prevalence. Numerous literature data indicate that high BMI is associated with increased mortality from cardiovascular diseases.

The aim: to study the relationship between overweight and generalized obesity with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and age.

Material and methods. This study was carried out as part of the international crosssectional epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up period was monitored in 1096 respondents out of 1341 initial cohorts (response – 82.1 %). The endpoints were cases of fatal and non-fatal cardiovascular events. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, survival by the Kaplan – Meier method).

Results. A total of 181 cases of fatal and non-fatal cardiovascular events (16.44 %) were recorded during the follow-up. In persons with normal body weight, the incidence of cardiovascular complications was 10 %. In overweight individuals, the value of this indicator increased and reached 17.99 % (p˂ 0.001), and in individuals with obesity – 24.5 % (p˂ 0.0001). The increase in the frequency of events with the increase in body mass index did not depend on the gender of the respondents but was typical only for people under 60 years of age. For elderly patients, there was no relationship between BMI and the development of cardiovascular complications. In contrast, the relative risk had an insignificant tendency to decrease by 2.6 % for every 1 kg/m2 increase in body mass index (RR – 0.974; 95% CI: 0.924–1.025).

Conclusion. The increase of body mass index above 25 kg/m2 is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of the Chui region residents, regardless of gender, but only in persons under 60 years of age. 

Cognitive Behavioral Approach to Treat Obesity: A Randomized Clinical Trial

Our aim was to analyze and compare the effects of three different long-term treatments on anthropometric profiles, eating behaviors, anxiety and depression levels, and quality of life of groups of adults with obesity. Methods: The 43 participants in the study were randomly assigned to one of three groups: the education and health group (EH, n = 12), which received lectures on health topics; the physical exercise group (PE, n = 13), which underwent physical training; and the interdisciplinary therapy plus cognitive behavioral therapy (IT + CBT) (n = 18) group, which received physical training, nutritional advice, and physical and psychological therapy. Results: Total quality of life increased significantly in the EH group (△ = 2.00); in the PE group, body weight significantly decreased (△ = -1.42) and the physical domain of quality of life improved (△ = 1.05). However, the most significant changes were seen in the IT + CBT group, in which the anthropometric profile improved; there were an increase in quality of life in all domains (physical, psychological, social, and environmental), an improvement in eating behaviors [Dutch Eating Behavior Questionnaire (DEBQ), total △ = -8.39], and a reduction in depression [Beck Depression Inventory (BDI), △ = -10.13). Conclusion: The IT + CBT program was more effective than the PE and EH programs. Clinical Trial Registration Number: NCT02573688.

Abdominal obesity and association with sociodemographic, behavioral and clinical data in climacteric women assisted in primary care

This study aims to investigate the prevalence and factors associated with abdominal obesity in climacteric women assisted at Family Health Strategy units of the city of Montes Claros, State of Minas Gerais, Brazil. It is a cross-sectional analytical study. The women were selected by probabilistic sampling from August 2014 to August 2015. A questionnaire containing information referring to sociodemographic and economic characteristics, behavioral characteristics and clinical data was used. To estimate abdominal obesity, the measure of circumference ≥ 88 cm was considered. To analyze the association between abdominal obesity and the independent variables, a bivariate analysis was performed by means of Pearson’s chi-square test (p≤0.25). Subsequently, a multiple Poisson regression analysis with robust variance was performed, through which prevalence ratios with level of significance of 5% (p<0.05) were obtained. A total of 805 women were evaluated, aged 40 to 65 years, and the prevalence of women with abdominal obesity was 62.4%. The mean and median of abdominal circumference were 93.0 cm. The associated variables were being sedentary (PR = 1.44) or irregularly active (PR = 1.39), presenting altered total cholesterol (PR = 1.21), and being hypertensive (PR = 1.31). The abdominal obesity in climacteric women was associated with physical inactivity, total cholesterol and arterial hypertension. The measurement of abdominal circumference must be valued and adopted in the routine of professionals who work in Primary Care.