Assessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland-Altman plots. Validation was based on forty obese women (BMI 30-39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris-Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris-Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland-Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris-Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.
Long-term interdisciplinary therapy was effective in decreasing the intake of calories, carbohydrates, and fats. The therapy positively changed the body composition and reduced anthropometric measurements. However, the intake of some micronutrients after therapy was still significantly lower than recommended. These results demonstrated that the proposed interdisciplinary methodology can be effective in treating obesity; however, the present study reinforced the need to address the micronutrient deficiency in the target population.
Hyperleptinemia has emerged as a marker of proinflammatory status, while the adiponectin/leptin ratio has been used to identify anti-inflammatory state. In this context, the aims of the present study were to investigate the role of leptinemia, adjusted by tertiles, on inflammatory state in obese adults according to obesity degree. This is a cross-sectional study comprised of 43 obese adults. The anthropometric variables and body composition were analyzed, as well as markers of inflammation such as leptin, adiponectin, and plasminogen activator inhibitor. Subjects were grouped using adjusted tertiles of the leptin levels. The major finding was the negative correlation between leptin concentration with adiponectin/leptin ratio (r=-0.622, p=0.000) and the positive correlation with leptin/adiponectin ratio (r=0.622, p=0.000). Indeed, both ratios were decreased and increased, respectively, according to the obesity degree. Furthermore, in the stepwise multiple linear regression analysis, the high degree of obesity was an independent predictor of leptinemia when adjusted for age and BMI (β=0.588, p=0.000 and β=0.778, p=0.005). Finally, the strong negatively correlation between the leptinemia with adiponectin/leptin ratio and the positive correlation with leptin/adiponectin ratio reinforce the role of this adipokine as a biomarker of inflammation in obese adults, according to obesity degree. Our findings can elucidate that hyperleptinemic status was a major factor in the proinflammatory status related to higher obesity degree. All together, these data reinforce the role of leptinemia state as a mediator of inflammation in obese adults.
ResumoIntrodução: A obesidade é uma doença crônica multifatorial de proporções epidêmicas. O sedentarismo e hábitos alimentares pouco saudáveis são considerados seus principais fatores etiológicos. Estudos recentes apontam que o tratamento interdisciplinar pode promover benefícios favorecendo a perda de peso e a melhora da qualidade de vida. Objetivo: Verificar o efeito de 20 semanas de um programa de terapia interdisciplinar de mudança de estilo de vida no consumo máximo de oxigênio, na composição corporal e nos parâmetros antropométricos de mulheres adultas obesas. Metodologia: vinte e nove voluntárias do gênero feminino, com idade entre 30 e 50 anos e índice de massa corporal (IMC) entre 30 e 40 Kg/m², foram submetidas a 20 semanas da terapia interdisciplinar, composta por cinco intervenções semanais, sendo três de exercícios físicos, uma de nutrição e uma de psicologia, com duração de 60 minutos cada intervenção. Foi avaliada a composição corporal e a aptidão aeróbia através de um teste ergoespirométrico máximo. Resultados: Pós-terapia foi encontrado uma redução significativa na massa corporal (-4,71% p<0,001), IMC (-4,72% p<0,001) e perímetros analisados, como o perímetro abdominal (-6,03% p<0,001). Foi verificado também uma melhora significativa na composição corporal, diminuindo a gordura corporal (-2,2% p<0,001) e no consumo máximo de oxigênio relativo ao peso (+ 15,79% p<0,001) e absoluto (+ 10,91% p<0,001). Conclusão: Após 20 semanas, a terapia interdisciplinar apresentou efeitos benéficos em mulheres obesas o que reforça este modelo como uma estratégia viável para o tratamento da obesidade clínica, melhora da composição corporal e aptidão aeróbia. (-4.71%, p <0.001), BMI (-4.72%, p <0.001) and perimeters, such as the abdominal circumference (-6.03 wt% <0.001). We also noticed a significant improvement in body composition, reducing body fat (-2.2%, p <0.001) and maximal oxygen consumption relative to weight (+ 15.79% p <0.001) and absolute (+ 10.91% p <0.001 Palavras-chave
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