Analisar os efeitos da razão leptina/adiponectina no processo inflamatório e no balanço energético de mulheres adultas com obesidade após terapia interdisciplinar semipresencial para o controle de peso, e sua relação com fatores nutricionais
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Date
2020-04-30
Authors
Shiba, Carolina Kim [UNIFESP]
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Damaso, Ana Raimunda [UNIFESP]
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Dissertação de mestrado
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Abstract
Introdução: A obesidade é uma doença crônica, de causa multifatorial. Está relacionada com hábitos alimentares inadequados que comprometem a qualidade do consumo de nutrientes, o aumento de calorias, somados com os níveis reduzidos de atividade física. O acúmulo excessivo de gordura aumenta os riscos de doenças cardiovasculares, resistência à insulina e aumento de fatores pró inflamatórios. O tratamento da obesidade deve ser de forma individualizada, com o objetivo de propor uma alimentação de melhor qualidade nutricional, assim como o aumento dos níveis de atividade física, visando criar um estilo de vida saudável. Objetivos: Analisar os efeitos da leptina e adiponectina no processo inflamatório e no balanço energético de mulheres adultas com obesidade em terapia multiprofissional para o controle de peso, e sua relação com fatores nutricionais. Métodos: 100 mulheres com idade entre 20 a 45 anos, que apresentavam obesidade, foram recrutadas a partir de anúncios veiculados a mídias sociais para a intervenção semipresencial com foco nas mudanças no estilo de vida. A terapia multiprofissional que teve duração de 12 semanas, contava com o apoio médico, nutricional, orientações sobre atividade física e suporte eletrônico. No período inicial e final, foram avaliados: a massa corporal, estatura, perímetros de cintura, quadril e pescoço, foi feita a avaliação da composição corporal, avaliação nutricional, nível de atividade física e pressão arterial em repouso. Assim como as coletas sanguíneas e análises bioquímicas. Resultados: A terapia mostrou-se eficaz na redução da massa corporal (de 93.16 ± 16.96 para 88.36 ± 16.23; p=0.0000001), índice de massa corporal (de 34.01 ± 4 para 32.29 ± 3.96; p=0.0000001), e gordura corporal (de 38.25 ± 5.05 para 36.13 ± 5; p=0.0000001). Houve também uma melhora no perfil lipídico, incluindo colesterol total (de 196.16 ± 34.78 para 183.53 ± 43.15; p=0.001), colesterol não HDL (de 142 ± 30.05 para 1333.69 ± 35.41; p=0.01), colesterol VLDL (de 27.13 ± 12.4 para 22.06 ± 8.55; p=0.002), triglicerídeos (de 135.88 ± 61.21 para 110.75 ± 43.09; p=0.002) e metabolismo da glicose, incluindo glicose (de 97.13 ± 10.43 para 92.6 ± 6.6; p=0.004), e insulina (de 13.05 ± 5.54 para 11.29 ± 4.85; p=0.03). Quanto à ingestão de alimentos, houve redução no consumo de calorias (de 1991.45 ± 677.78 para 1468.88 ± 390.56; p=0.002), carboidratos (de 50.37 ± 6 para 47.04 ± 8.67; p=0.04), lipídios (de 31.83 ± 5.53 para 30.37 ± 7.04; p=0.3), carga glicêmica (de 80.53 ± 39.88 para 54.79 ± 23.69; p=0.02) e aumento no consumo de proteínas (de 18.3 ± 2.39 para 22.89 ± 4.9; p=0.002). Correlações positivas foram demonstradas entre a concentração de insulina e o perímetro de cintura (r 0.82; p=0.003); leptina com gordura corporal e perímetro abdominal (r 0.74; p=0.01); fração LDL-colesterol com consumo total de colesterol (r 0.69; p=0.027). Correlações negativas foram demonstradas entre leptina e consumo de gordura monossaturada (r -0.71; p=0.02); adiponectina com enzima hepática GGT (r -0.65; p=0.04). Conclusão: A terapia multiprofissional teve efeitos positivos no estado inflamatório, mediado pela leptina, adiponectina e qualidade da dieta, incluindo a diminuição da carga glicêmica, a gordura saturada e o aumento da ingestão de proteínas. Nossos resultados sugerem a eficácia e a relevância clínica da terapia clínica multiprofissional aplicada à obesidade.
Introduction: Obesity is a chronic disease with a multi-professional cause. It is related to inappropriate eating habits that compromise the quality of nutrient consumption, the increase in calories, added to the reduced levels of physical activity. Excessive fat accumulation increases the risk of cardiovascular disease, insulin resistance and increased pro-inflammatory factors. The treatment of obesity must be individualized, with the aim of proposing a better nutritional quality diet, as well as increasing levels of physical activity, aiming to create a healthy lifestyle. Objectives: To analyze the effects of leptin and adiponectin on the inflammatory process and energy balance of adult women with obesity in interdisciplinary therapy for weight control, and their relationship with nutritional factors. Methods: 100 women aged 20 to 45 years, who were obese, were recruited from advertisements on social media for the semi-face-to-face intervention focusing on changes in lifestyle. The multi-professional therapy, which lasted 12 weeks, had medical and nutritional support, guidance on physical activity and electronic support. In the initial and final period, weight, height, waist circumference, hip and neck were evaluated, body composition, nutritional assessment, physical activity level and blood pressure at rest were assessed. As well as blood collections and biochemical analyzes. Results: The therapy showed to be effective in reducing body weight (from 93.16 ± 16.96 to 88.36 ± 16.23; p=0.0000001), body mass index (from 34.01 ± 4 to 32.29 ± 3.96; p=0.0000001), and body fat (from 38.25 ± 5.05 to 36.13 ± 5; p=0.0000001). There was also an improvement in lipid profile, including total cholesterol (from 196.16 ± 34.78 to 183.53 ± 43.15; p=0.001), non HDL-cholesterol (from 142 ± 30.05 to 1333.69 ± 35.41; p=0.01), VLDL-cholesterol (from 27.13 ± 12.4 to 22.06 ± 8.55; p=0.002), triglycerides (from 135.88 ± 61.21 to 110.75 ± 43.09; p=0.002) and glucose metabolism, including glucose (from 97.13 ± 10.43 to 92.6 ± 6.6; p=0.004), insulin (from 13.05 ± 5.54 to 11.29 ± 4.85; p=0.03). As for food intake, there was decrease in the consumption of calories (from 1991.45 ± 677.78 to 1468.88 ± 390.56; p=0.002), carbohydrates (from 50.37 ± 6 to 47.04 ± 8.67; p=0.04), lipids (from 31.83 ± 5.53 to 30.37 ± 7.04; p=0.3), glycemic load (from 80.53 ± 39.88 to 54.79 ± 23.69; p=0.02) and increased consumption of proteins (from 18.3 ± 2.39 to 22.89 ± 4.9; p=0.002). Positive correlations were demonstrated between the concentration of insulin with waist circumference (r 0.82; p=0.003); leptin with body fat and abdominal circumference (r 0.74; p=0.01); LDL-cholesterol fraction with total cholesterol consumption (r 0.69; p=0.027). Negative correlations were demonstrated between leptin and monosaturated fat consumption (r -0.71; p=0.02); adiponectin with GGT liver enzyme (r -0.65; p=0.04). Conclusion: Interdisciplinary therapy had positive effects on the inflammatory state, mediated by leptin, adiponectin and quality of the diet, including decreased glycemic load, saturated fat and increased protein intake. Our results suggest the efficacy and clinical relevance of multi-professional clinical therapy applied to obesity.
Introduction: Obesity is a chronic disease with a multi-professional cause. It is related to inappropriate eating habits that compromise the quality of nutrient consumption, the increase in calories, added to the reduced levels of physical activity. Excessive fat accumulation increases the risk of cardiovascular disease, insulin resistance and increased pro-inflammatory factors. The treatment of obesity must be individualized, with the aim of proposing a better nutritional quality diet, as well as increasing levels of physical activity, aiming to create a healthy lifestyle. Objectives: To analyze the effects of leptin and adiponectin on the inflammatory process and energy balance of adult women with obesity in interdisciplinary therapy for weight control, and their relationship with nutritional factors. Methods: 100 women aged 20 to 45 years, who were obese, were recruited from advertisements on social media for the semi-face-to-face intervention focusing on changes in lifestyle. The multi-professional therapy, which lasted 12 weeks, had medical and nutritional support, guidance on physical activity and electronic support. In the initial and final period, weight, height, waist circumference, hip and neck were evaluated, body composition, nutritional assessment, physical activity level and blood pressure at rest were assessed. As well as blood collections and biochemical analyzes. Results: The therapy showed to be effective in reducing body weight (from 93.16 ± 16.96 to 88.36 ± 16.23; p=0.0000001), body mass index (from 34.01 ± 4 to 32.29 ± 3.96; p=0.0000001), and body fat (from 38.25 ± 5.05 to 36.13 ± 5; p=0.0000001). There was also an improvement in lipid profile, including total cholesterol (from 196.16 ± 34.78 to 183.53 ± 43.15; p=0.001), non HDL-cholesterol (from 142 ± 30.05 to 1333.69 ± 35.41; p=0.01), VLDL-cholesterol (from 27.13 ± 12.4 to 22.06 ± 8.55; p=0.002), triglycerides (from 135.88 ± 61.21 to 110.75 ± 43.09; p=0.002) and glucose metabolism, including glucose (from 97.13 ± 10.43 to 92.6 ± 6.6; p=0.004), insulin (from 13.05 ± 5.54 to 11.29 ± 4.85; p=0.03). As for food intake, there was decrease in the consumption of calories (from 1991.45 ± 677.78 to 1468.88 ± 390.56; p=0.002), carbohydrates (from 50.37 ± 6 to 47.04 ± 8.67; p=0.04), lipids (from 31.83 ± 5.53 to 30.37 ± 7.04; p=0.3), glycemic load (from 80.53 ± 39.88 to 54.79 ± 23.69; p=0.02) and increased consumption of proteins (from 18.3 ± 2.39 to 22.89 ± 4.9; p=0.002). Positive correlations were demonstrated between the concentration of insulin with waist circumference (r 0.82; p=0.003); leptin with body fat and abdominal circumference (r 0.74; p=0.01); LDL-cholesterol fraction with total cholesterol consumption (r 0.69; p=0.027). Negative correlations were demonstrated between leptin and monosaturated fat consumption (r -0.71; p=0.02); adiponectin with GGT liver enzyme (r -0.65; p=0.04). Conclusion: Interdisciplinary therapy had positive effects on the inflammatory state, mediated by leptin, adiponectin and quality of the diet, including decreased glycemic load, saturated fat and increased protein intake. Our results suggest the efficacy and clinical relevance of multi-professional clinical therapy applied to obesity.