Obesity and the risk of heart failure

This is an overview of the mechanisms of obesity and its relation to cardiovascular risks, describing the available treatment options to manage this condition. The pathogenesis of obesity includes the balance between calories consumed and energy expenditure followed by the maintenance of body weight. Diet, physical activity, environmental, behavioral and physiological factors are part of the complex process of weight loss, since there are several hormones and peptides involved in regulation of appetite, eating behavior and energy expenditure. The cardiovascular complications associated to obesity are also driven by processes involving hormones and peptides and which include inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin angiotensin or the sympathetic nervous systems. Pharmacological treatments are often needed to insure weight loss and weight maintenance as adjuncts to diet and physical activity in people with obesity and overweight patients. To accomplish satisfactory goals, patients and physicians seek for weight loss, weight maintenance and improvement of the risk factors associated to this condition, especially cardiovascular risk.

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Cardiovascular risk and obesity

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

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ERICA: prevalences of hypertension and obesity in Brazilian adolescents

High serum free fatty acid (FFA) levels are associated with metabolic syndrome (MS). This study aimed to assess the association of fasting serum FFAs with nonalcoholic fatty liver disease (NAFLD) in a Chinese population. A total of 840 subjects fulfilled the diagnostic criteria of NAFLD and 331 healthy control participants were enrolled in this cross-sectional study. Fasting serum FFA levels and other clinical and laboratory parameters were measured. NAFLD patients had significantly higher serum FFA levels than controls (P < 0.001). Serum FFA levels were significantly and positively correlated with parameters of MS, inflammation indexes, and markers of hepatocellular damage. Elevated serum FFA levels were found in NAFLD subjects with individual components of MS (obesity, hypertriglyceridaemia, and hyperglycaemia). Stepwise regression showed that serum FFA levels were an independent factor predicting advanced fibrosis (FIB-4 ≥ 1.3) in NAFLD patients. Serum FFA levels correlated with NAFLD and could be used as an indicator for predicting advanced fibrosis in NAFLD patients.

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Association between serum free fatty acid levels and nonalcoholic fatty liver disease: a cross-sectional study

OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended ( 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.

https://scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/rsp/v50s1/0034-8910-rsp-S01518-87872016050006698.pdf

ERICA: intake of macro and micronutrients of Brazilian adolescents

Objective: To describe the role of high sensitivity C-reactive protein in atherosclerosis, and to point out researches that found an association of the protein, a marker of low-grade infl ammation, with other cardiovascular risk factors in childhood and adolescence. Data source: A search was performed in electronic databases Scientifi c Electronic Library Online (SciELO) and Medical Literature Analysis (MEDLINE) using the keywords "cardiovascular disease"; "infl ammation"; "child"; "adolescent" and "obesity". Other sources of information were Internet data published by offi cial bodies: American Heart Association and U.S. Food and Drug Administration. Data summary: We selected original and review articles, published between 2000 and 2011. C-reactive protein act in several ways on the vascular endothelium. Multiple cardiovascular risk factors were associated with high sensitivity C-reactive protein in childhood and adolescence. Conclusion: The results of the literature review show that there is an association between high sensitivity C-reactive protein and other cardiovascular risk factors in childhood and adolescence.

Proteína C reativa e risco cardiovascular em crianças e adolescentes

Association between polyunsaturated fatty acids intake and insulin resistance in Brazilian adolescents (ERICA Study).

Objective: To characterize the metabolic syndrome and verify the prevalence in adolescence. Data sources: National and international literature revision based on MEDLINE database, from 2000 to 2008. Data Synthesis: The metabolic syndrome is not formally recognized in children and adolescents, due to this fact, there is not a consensus about the defi nition, this occur in part due to changes in the Clinical and metabolic characteristics associates to infancy and puberty that diffi cult the creation of a SM defi nition for these age. The SM defi nition used to children and adolescents consists in to be greater than the adult defi nition. Studies using a variety of defi nitions have shown an alarming increase of SM components. This suggests an increase of SM prevalence in children and adolescents and a new public health concern with serious consequences. Conclusions: It is important to emphasize that the attention to isolated components called SM is of great importance. Prevention and control of risk factors, as example, obesity or hypertension must be of great priority, independently of the presence of other risk factors, satisfying the SM defi nition.

Denise Tavares Giannini

Papers

Proteína C reativa e risco cardiovascular em crianças e adolescentes

Association between polyunsaturated fatty acids intake and insulin resistance in Brazilian adolescents (ERICA Study).

Diagnóstico e prevalência da síndrome metabólica na adolescência