Perfil de risco cardiometabólico e resposta ao tratamento clínico da obesidade de acordo com a fase de início da obesidade e seus fatores desencadeantes
Data
2020-11-26
Autores
Prado, Marta Germano
Orientadores
Pititto, Bianca de Almeida [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A obesidade possui status de epidemia global com tendência crescente e está associada a morbimortalidade e incapacidades (físicas, psíquicas, sociais entre outras), tornando relevante o investimento em maior conhecimento sobre fatores de risco e medidas de controle e tratamento do excesso de peso. O tratamento clínico da obesidade consiste em mudança de estilo de vida, podendo ou não ser utilizado fármaco como coadjuvante para perda de peso, porém, possui baixa taxa de sucesso - representada por perda igual ou maior a 10% do peso inicial. Dentre os fatores relacionados a fases da vida podemos citar o momento em que iniciou a obesidade, o fator desencadeante e histórico familiar de obesidade. Esclarecer se esses fatores estão associados com pior perfil cardiometabólico e se influenciam a resposta ao tratamento clínico pode contribuir para o entendimento da história natural e nortear melhor efetividade no controle da obesidade. Objetivo: Avaliar se o período da vida relatado como início do excesso de peso e seus fatores desencadeantes estão associados a diferenças no perfil cardiometabólico atual e em diferenças na resposta ao tratamento clínico da obesidade em adultos acompanhados no ambulatório de obesidade do Hospital do Rim (HRim) da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP). Materiais e Métodos: Trata-se de um estudo do tipo quantitativo, observacional e transversal a ser realizado com pacientes (n = 125) com idade superior a 17 anos, de ambos os sexos, que não tenham sido submetidos à cirurgia bariátrica e que tenham um ano de acompanhamento ambulatorial no mínimo. Os indivíduos foram estratificados de acordo com a fase da vida em que relataram ter iniciado a obesidade (infância ou adolescência e vida adulta) e, em uma segunda análise, pela resposta ao tratamento clínico (ganho ou manutenção do peso - falha no tratamento, perda de peso < 10 % - pouca resposta, e perda de peso ≥ 10 %, sucesso no tratamento). As variáveis de interesse foram analisadas de acordo com o grupo de estratificação. Foram considerados fatores de risco cardiometabólicos: dislipidemia, hipertensão arterial e diabetes mellitus do tipo 2 e doenças cardiovasculares (relatada em prontuário). Resultados: O grupo que iniciou a obesidade na infância ou adolescência (n=40) apresentou maior média (DP) de IMC [44,8 (7,7) vs. 40,3 (6,7) kg/m2 , p = 0,020] e era mais jovens [35,8 (10,3) vs. 47,9 (10,5), p< 0,001] do que os que iniciaram obesidade na vida adulta (n=84), mas não houveram diferenças entre esses grupos em relação a variáveis sociodemográfica, duração de obesidade e história familiar de obesidade. Observamos que o grupo que iniciou a obesidade na infância ou adolescência referiu, em maior proporção, dieta inadequada e sedentarismo como fatores desencadeantes da obesidade. Apesar de mais jovens durante o tratamento atual, o grupo que iniciou a obesidade na infância ou adolescência apresentou maior frequência de obesidade severa (IMC ≥ 40 kg/m2) [29 (72,5) % vs. 42 (50,0) %, p=0,018)] do que aqueles que relatam obesidade somente na vida adulta, enquanto que a frequência de 3 ou mais fatores de risco cardiometabólicos foi semelhante nos dois grupos [15 (29,4) % vs. 36 (42,1) %, p=0,705) respectivamente. Em relação a resposta ao tratamento clínico da obesidade o grupo de falha no tratamento apresentou diferença percentual de peso em mediana (intervalo interquartil) de 3,3 (1,0 a 6,6) %, o grupo de pouca resposta, de -3,6 (-6,7 a -1,9) % ,e o grupo de sucesso de tratamento, de -14,7 (-18,4 a -12,6) % (p = 0,000). Não houveram diferenças entre os grupos de resposta ao tratamento em relação a sexo, idade, história de obesidade na família, duração da obesidade, fatores precipitantes da obesidade, perfil cardiometabólico, bem como tempo de acompanhamento clínico, uso de medicação e acompanhamento com psicólogo e nutricionistas. Relevante notar que o grupo que iniciou a obesidade na infância ou adolescência, apesar de ser mais jovem do que o grupo que iniciou obesidade na vida adulta, apresentou resposta semelhante em relação à perda de peso corporal durante o seguimento [-2,2 (-6,4 a 3,5) vs. -2,6 (-7,9 a 1,0) kg, p = 0,98] respectivamente. Não observamos, também, diferenças estatisticamente significativas entre as perdas de peso durante o acompanhamento considerando estratificação pelas medianas da idade cronológica (< ou ≥ a 35 anos) e do tempo de obesidade (< e ≥ a 17 anos). Foi observado que o grupo de sucesso no tratamento apresentou maior porcentagem de redução de peso no primeiro ano de acompanhamento [-11,4 (-14,8 a -7,8)% vs. -3,3 (-6,8 a -1,5) % vs. 1,5 (0,3 a 5,9) % (p = 0,000)] e maior frequência na prática atividade física semanal ≥ 150 minutos [60,0% vs. 14,3% vs 7,4 %., p < 0,001] do que os grupos de pouca resposta e de falha no tratamento clínico respectivamente. Dentre aqueles que tiveram sucesso no tratamento, 55,6 % já tinham atingido uma perda de ≥ 10 % no primeiro ano e 100 % perderam ≥ 5 % nesse mesmo período. Conclusões: Nossos achados mostraram que os pacientes com início da obesidade na infância ou adolescência, apesar de mais jovens, não diferiram quanto ao perfil cardiometabólico e de resposta ao tratamento clínico quando comparados indivíduos que referiram aumento de peso na vida adulta. O tempo de exposição à obesidade e fatores desencadeantes da obesidade não influenciaram a resposta de perda de peso. Em concordância com o conhecimento científico atual, sucesso de perda de peso após 3 anos de acompanhamento clínico foi associado à prática de atividade física e a maior perda de peso durante o primeiro ano de tratamento. Nossos resultados podem sugerir que a obesidade iniciada precocemente no ciclo da vida pode ser mais severa e mais resistente a perda de peso.
Introduction: Obesity has a global epidemic status with na increasung trend and is associated with morbimortality and desability, wich makes it importante to calrify the control and treatment measures. Obesity clinical treatment is based in lifestyle change with or without anorexigenic medication use as adjuvante for weight loss. Clinical treatment has low rate of success wich is a weight loss of 10 % or more of initial weight. Risk factors of this desease in cycle of life and lifestyle are strongly associated with overweight e its comorbidities. Among the factors related to life stages we can mention phase of onset of obesity, precipitating factors and Family history of obesity. Clarify if these factors are associated with worst cardiometabolic profile and if they influence clinical treatment response can contribute to the understanding of natural history and guide better effectiviness of obesity control. Objectives: To evaluate if phase of onset of obesity reported by the patients and its precipitating factors are associated with diferences in actual cardiometabolic profile and diferences in obesity clinical treatment response in adults subjects followed up in obesity clinic in the Hospital do Rim (HRim) of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM-UNIFESP). Marterials and Methods: It is a cross-sectional study realized with patients (n = 125) that are more than 17 years old, both sex, have not un- dergone bariatric surgery and have been followed for at least one year. Subjects were stratified according to the phase of onset of obesity (infancy or adolescence and adult life) and, in the second analyze, to the outcome of clinical treatment respone (weight gain or maintenance of initial body weight, loss of weight between 0,1 and 9,9 % - low response group and weight loss ≥ 10 % - treatment success). Independent variables were analized according to estratified groups. Cardiometabolic risk factors like diabetes type 2, hypertension, dyslipidemia and cardiovascular desease were considered (reported in medical records). Results: The infancy or adolescence group of onset of obesity (n=40) had a bigger average (DP) of BMI [44.8 (7,7) vs. 40,3 (6.7) kg/m2, p = 0,020] and were younger [35.8 (10.3) years vs. 47.9 (10.5) years, p < 0,001]than the adulthood group of onset of obesity (n=84) in the beggining of the treatment, but there were not diferences in sociodemographic variables, in time of duration of obesity and family history of obesity. It was observed that the juvenile group of onset of obesity refered, in higher proportion, unhealthy diet and sedentary lifestyle as precipitating factors of obesity. Although younger at the presente time, this group presented higher frequency of severe obesity (IMC ≥ 40 kg/m2) [29 (72.5) % vs. 42 (50.0) %, p=0.018)] while the proportion of 3 or more cardiometabolic risks were similar in both groups [15 (29.4) % vs. 36 (70.6) %, p=0.705] respectivitly. In relation to the obesity clinical treatment response, 43 (34.4 %) maintenenced or gained weight compared to initial weight (no response group), 63 (50.4) % lost 0.1 to 9.9 % of initial weight (low response group) and 19 (15.2) % lost ≥ 10 % of initial weight (treatment success group). There were no diferences betwwen clinical treatment response and sex, age, Family histoty of obesity, time of duration of obesity, preciptating facotrs of obesity, initial cardiometabolic profile, clinical follow-up time, medications use, psychological and dietition follw-up. It is relevant to note that the juvenile group, although younger, had similar treatment response during time of follow-up [-2.2 (-6.4 to 3.5) vs. -2.6 (-7.9 a 1.0) kg, p = 0.98]. We did not observed significant differences between loose of weight during treatment considering stratification by medians of chronological age cronológica (< ou ≥ 35 anos) or by time of duration of obesity (< e ≥ 17 anos). Success group of treatment presented bigger percentage of weight reduction in the first year of treatment [-11.4 (-14.8 to -7.8)% vs. -3.3 (-6.8 to -1.5)% vs. 1.5 (0,3 a 5,9)% of weight gain in the group of no response during treatment, in the group of low response and in the group of treatment succes (p=0,000)] and bigger frequency of physical activity ≥ 150 minutes/week [60.0% vs. 14.3% vs 7.4 %., p < 0,001] compared to the group of low response and to the group of no response during treatment respectily. Ealier phase of onset of obesity group, even they were younger in the beggining of the treatment, did not loose more weight than the later onset group of obesity. No significant statistics differences were observed in weight loss during treatment considering stratifications by medians in cronologic age < or ≥ a 35 years and by the time of duration of obesity < or ≥ 17 years. It was observed that the group that lost ≥ 10 % of initial body weight had higher reduction of weight in the first year of treatment 2.2 (4.7) % vs. – 4.0 (4.1) % vs. – 12.8 (7.8) % (p < 0,010) (the first group gained weight and the second and third lost it) and higher frequency of physical activity practice of ≥ 150 minutes/week than those that maintened or gained weight or lost 0,1 to 9,9% of initial body weight during treatment 2 (7.4) % vs. 7 (14.3) % e 9 (60.0) % (p < 0,001) respectively. Clinical treatment response groups had differences in weight reduction in the first year of follow-up [2.2(4.7)% of maintenenced or gained of weight group during treatment, 4.0(4.1)% in low response group during follow-up and 12.8(7.8)% in the success treatment group (p<0,001)] and in the percentual of individuals that refered physical activity practice ≥ 150 minutes/week (7.5%, 14.3% and 60% respectively (p<0,001). Between those who lost de ≥10% of initial weight, 55.6 % achived that lost in the first year of follow-up and 100% lost de ≥ 5% in this same period. Conclusions: We found that infancy or adolscence phases of onset of obesity group were younger, but did not differ between cardiometabolic profile and clinical treatment response compared to adult phase of onset of obesity group. Time of duration of obesity did not influenced in loose of weight. In relation to the actual knowlodge, weight loss in 3 years of follow-up was associated to physical activity practice and bigger weight loss in the first year of treatment. Our results can suggest that earlier phase of onset of obesity could be more severe and more resistent to weight loss.
Introduction: Obesity has a global epidemic status with na increasung trend and is associated with morbimortality and desability, wich makes it importante to calrify the control and treatment measures. Obesity clinical treatment is based in lifestyle change with or without anorexigenic medication use as adjuvante for weight loss. Clinical treatment has low rate of success wich is a weight loss of 10 % or more of initial weight. Risk factors of this desease in cycle of life and lifestyle are strongly associated with overweight e its comorbidities. Among the factors related to life stages we can mention phase of onset of obesity, precipitating factors and Family history of obesity. Clarify if these factors are associated with worst cardiometabolic profile and if they influence clinical treatment response can contribute to the understanding of natural history and guide better effectiviness of obesity control. Objectives: To evaluate if phase of onset of obesity reported by the patients and its precipitating factors are associated with diferences in actual cardiometabolic profile and diferences in obesity clinical treatment response in adults subjects followed up in obesity clinic in the Hospital do Rim (HRim) of Escola Paulista de Medicina of Universidade Federal de São Paulo (EPM-UNIFESP). Marterials and Methods: It is a cross-sectional study realized with patients (n = 125) that are more than 17 years old, both sex, have not un- dergone bariatric surgery and have been followed for at least one year. Subjects were stratified according to the phase of onset of obesity (infancy or adolescence and adult life) and, in the second analyze, to the outcome of clinical treatment respone (weight gain or maintenance of initial body weight, loss of weight between 0,1 and 9,9 % - low response group and weight loss ≥ 10 % - treatment success). Independent variables were analized according to estratified groups. Cardiometabolic risk factors like diabetes type 2, hypertension, dyslipidemia and cardiovascular desease were considered (reported in medical records). Results: The infancy or adolescence group of onset of obesity (n=40) had a bigger average (DP) of BMI [44.8 (7,7) vs. 40,3 (6.7) kg/m2, p = 0,020] and were younger [35.8 (10.3) years vs. 47.9 (10.5) years, p < 0,001]than the adulthood group of onset of obesity (n=84) in the beggining of the treatment, but there were not diferences in sociodemographic variables, in time of duration of obesity and family history of obesity. It was observed that the juvenile group of onset of obesity refered, in higher proportion, unhealthy diet and sedentary lifestyle as precipitating factors of obesity. Although younger at the presente time, this group presented higher frequency of severe obesity (IMC ≥ 40 kg/m2) [29 (72.5) % vs. 42 (50.0) %, p=0.018)] while the proportion of 3 or more cardiometabolic risks were similar in both groups [15 (29.4) % vs. 36 (70.6) %, p=0.705] respectivitly. In relation to the obesity clinical treatment response, 43 (34.4 %) maintenenced or gained weight compared to initial weight (no response group), 63 (50.4) % lost 0.1 to 9.9 % of initial weight (low response group) and 19 (15.2) % lost ≥ 10 % of initial weight (treatment success group). There were no diferences betwwen clinical treatment response and sex, age, Family histoty of obesity, time of duration of obesity, preciptating facotrs of obesity, initial cardiometabolic profile, clinical follow-up time, medications use, psychological and dietition follw-up. It is relevant to note that the juvenile group, although younger, had similar treatment response during time of follow-up [-2.2 (-6.4 to 3.5) vs. -2.6 (-7.9 a 1.0) kg, p = 0.98]. We did not observed significant differences between loose of weight during treatment considering stratification by medians of chronological age cronológica (< ou ≥ 35 anos) or by time of duration of obesity (< e ≥ 17 anos). Success group of treatment presented bigger percentage of weight reduction in the first year of treatment [-11.4 (-14.8 to -7.8)% vs. -3.3 (-6.8 to -1.5)% vs. 1.5 (0,3 a 5,9)% of weight gain in the group of no response during treatment, in the group of low response and in the group of treatment succes (p=0,000)] and bigger frequency of physical activity ≥ 150 minutes/week [60.0% vs. 14.3% vs 7.4 %., p < 0,001] compared to the group of low response and to the group of no response during treatment respectily. Ealier phase of onset of obesity group, even they were younger in the beggining of the treatment, did not loose more weight than the later onset group of obesity. No significant statistics differences were observed in weight loss during treatment considering stratifications by medians in cronologic age < or ≥ a 35 years and by the time of duration of obesity < or ≥ 17 years. It was observed that the group that lost ≥ 10 % of initial body weight had higher reduction of weight in the first year of treatment 2.2 (4.7) % vs. – 4.0 (4.1) % vs. – 12.8 (7.8) % (p < 0,010) (the first group gained weight and the second and third lost it) and higher frequency of physical activity practice of ≥ 150 minutes/week than those that maintened or gained weight or lost 0,1 to 9,9% of initial body weight during treatment 2 (7.4) % vs. 7 (14.3) % e 9 (60.0) % (p < 0,001) respectively. Clinical treatment response groups had differences in weight reduction in the first year of follow-up [2.2(4.7)% of maintenenced or gained of weight group during treatment, 4.0(4.1)% in low response group during follow-up and 12.8(7.8)% in the success treatment group (p<0,001)] and in the percentual of individuals that refered physical activity practice ≥ 150 minutes/week (7.5%, 14.3% and 60% respectively (p<0,001). Between those who lost de ≥10% of initial weight, 55.6 % achived that lost in the first year of follow-up and 100% lost de ≥ 5% in this same period. Conclusions: We found that infancy or adolscence phases of onset of obesity group were younger, but did not differ between cardiometabolic profile and clinical treatment response compared to adult phase of onset of obesity group. Time of duration of obesity did not influenced in loose of weight. In relation to the actual knowlodge, weight loss in 3 years of follow-up was associated to physical activity practice and bigger weight loss in the first year of treatment. Our results can suggest that earlier phase of onset of obesity could be more severe and more resistent to weight loss.