Obesidad/Obesity

Cambios en la actividad física pre y postoperatorios en pacientes de cirugía bariátrica: autoreporte vs mediciones objetivas  Pre- to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self-Report vs. Objective Measures Dale S. Bond, John M. Jakicic, Jessica L. Unick, Sivamainthan Vithiananthan, Dieter Pohl, G. Dean Roye, Beth A. Ryder, Harry C. Sax and Rena R. Wing Obesity (2010) 18, 2395-2397. doi:10.1038/oby.2010.88 Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre-op BMI = 50.8 ± 9.7 kg/m2) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥1-min and ≥10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥1-min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥10-min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated ≥150-in/week of MVPA in bouts ≥10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.88/pdf     Disfunción vascular en apnea obstructive del sueño y diabetes mellitus tipo 2  Vascular Dysfunction in Obstructive Sleep Apnea and Type 2 Diabetes Mellitus Susie Yim-Yeh, Shilpa Rahangdale, Anh Tu Duy Nguyen, Karen E. Stevenson, Victor Novack, Aristidis Veves  and Atul Malhotra Obesity (2011) 19, 17-22. doi:10.1038/oby.2010.116 Despite the high prevalence of obstructive sleep apnea (OSA) in type 2 diabetes mellitus (DM), the attributable vascular risk from each condition is unknown. We hypothesize that OSA may have a similar effect on vascular function as type 2 diabetes does. Healthy normal-weight subjects, healthy obese subjects, subjects with type 2 diabetes, and obese subjects with OSA were enrolled. Vascular function was assessed with brachial artery ultrasound for flowmediated dilatation (FMD) and in skin microcirculation by laser Doppler flowmetry. One hundred fifty-three subjects were studied: healthy normal-weight controls (NCs) (n = 14), healthy obese controls (OCs) (n = 33), subjects with DM (n = 68), and obese subjects with OSA (n = 38). The DM group did not undergo sleep study and thus may have had subclinical OSA. The OSA and type 2 diabetes groups had impaired FMD as compared to both the normal-weight and OC groups (5.8 ± 3.8%, 5.4 ± 1.6% vs. 9.1 ± 2.5%, 8.3 ± 5.1%, respectively, P < 0.001, post hoc Fischer test). When referenced to the NC group, a multiple linear regression model adjusting for covariates found that baseline brachial artery diameter (β = −3.75, P < 0.001), OSA (β = −2.45, P = 0.02) and type 2 diabetes status (β = −2.31, P = 0.02), negatively predicted % FMD. OSA status did not seem to affect nitroglycerin-induced vasodilation (endotheliumindependent) of the brachial artery or vascular function in the skin microcirculation. OSA impairs endothelial function in the brachial artery to a similar degree as type 2 diabetes does. OSA, however, does not appear to affect brachial endothelium-independent vasodilation or skin microcirculatory function. Treatment of OSA in patients with concomitant type 2 diabetes, therefore, may be a potential therapeutic option to improve macro-, but not microvascular outcomes. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.116/pdf  El efecto de la actividad física de 18 meses sobre el cambio de peso en adultos con sobrepeso meses   The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults John M. Jakicic, Amy D. Otto, Wei Lang, Linda Semler, Carena Winters, Kristen Polzien and Kara I. Mohr Obesity (2011) 19, 100-109. doi:10.1038/oby.2010.122 Few studies have been conducted that have examined the long-term effect of different doses of physical activity (PA) on weight change in overweight adults without a prescribed reduction in energy intake. This study examined the effect of different prescribed doses of PA on weight change, body composition, fitness, and PA in overweight adults. Two hundred seventy-eight overweight adults (BMI: 25.0-29.9 kg/m2; age: 18-55 years) with no contraindications to PA were randomized to one of three intervention groups for a period of 18 months. MOD-PA was prescribed 150 min/week and HIGH-PA 300 min/week of PA. Self-help group (SELF) was provided a self-help intervention to increase PA. There was no recommendation to reduce energy intake. MOD-PA and HIGH-PA were delivered in a combination of in-person and telephone contacts across 18 months. 18-month percent weight change was −0.7 ± 4.6% in SELF, −0.9 ± 4.7% in MOD-PA, and −1.2 ± 5.6% in HIGH-PA. Subjects were retrospectively grouped as remaining within ±3% of baseline weight (WT-STABLE), losing >3% of baseline weight (WT-LOSS), or gaining >3% of baseline weight (WT-GAIN) for secondary analyses. 18-month weight change was 0.0 ± 1.3% for WT-STABLE, +5.4 ± 2.6% for WT-GAIN, and −7.4 ± 3.6% for WT-LOSS. 18-month change in PA was 78.2 ± 162.6 min/week for WT-STABLE, 74.7 ± 274.3 for WT-GAIN, and 161.9 ± 252.6 min/week for WT-LOSS. The weight change observed in WT-LOSS was a result of higher PA combined with improved scores on the Eating Behavior Inventory (EBI), reflecting the adoption of eating behaviors to facilitate weight loss. Strategies to facilitate the maintenance of these behaviors are needed to optimize weight control. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.122/pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org