Mechanisms, Pathophysiology, and Management of Obesity

Heymsfield, Steven B.; Wadden, Thomas A.

doi:10.1056/nejmra1514009

Cited by 1,382 publications

(1,108 citation statements)

References 72 publications

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“…1 , 42 Any early risk-prediction marker that identifies these populations would be helpful to prevent the whole spectrum of both medical conditions. IR is a biochemical abnormality associated to these since the first stages in its pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

González-Saldivar

Rodríguez-Gutiérrez

Treviño-Alvarez

et al. 2018

Dermato-Endocrinology

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Any clinical/biochemical marker revealing obesity or diabetes before their appearance is valuable. Insulin resistance (IR) is present in both disorders many years before occurrence. Accordingly, we determined whether acanthosis nigricans (AN) in the knuckles is associated to higher insulin and homeostasis model assessment for estimated insulin resistance (HOMA-IR) index values, and assessed the influence of body-mass index (BMI) and the diagnostic performance of AN in the knuckles to detect IR. In this cross-sectional controlled study, we included men or women, 18 to 23 years old, with or without AN in the knuckles. In 149 cases with AN in the knuckles and 145 controls, fasting insulin was higher in cases (13.45 µU/mL ± 7.8 vs. 8.59 µU/mL ± 3.63, P < .001, respectively). Mean HOMA-IR index was also higher (2.86 ± 1.68 vs. 1.78 ± 0.77, P < .001). A significant increase in fasting insulin and HOMA-IR values between and within BMI groups from normal through obese category was identified in controls and cases. By multivariate regression analysis, cases with normal BMI were significantly associated to a HOMA-IR ≥2.5 (OR = 3.09, CI95% = 1.75–5.48, P = .001). A model of AN in the knuckles, normal BMI, and increased waist circumference allowed identifying 2 out of 3 cases with HOMA-IR index ≥2.5. AN in the knuckles could be addressed with two aims: as an easy, accessible, and costless diagnostic tool suggesting hyperinsulinemia secondary to IR, and, an early marker of IR even in the absence of overweight or obesity.

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Section: Discussionmentioning

confidence: 99%

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

González-Saldivar

Rodríguez-Gutiérrez

Treviño-Alvarez

et al. 2018

Dermato-Endocrinology

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“…O reganho de peso na CB é definido como o aumento ponderal que pode ocorrer a partir do menor peso pós-cirúr-gico 5 . A perda de peso ocorre de forma rápida no pós-operatório imediato, em função dos mecanismos de proteção metabólico e adaptação do paciente à restrição gástrica e ao aumento inicial da saciedade 5 .…”

Section: Introductionunclassified

“…A perda de peso ocorre de forma rápida no pós-operatório imediato, em função dos mecanismos de proteção metabólico e adaptação do paciente à restrição gástrica e ao aumento inicial da saciedade 5 . A diminuição ponderal, no entanto, tende a se estabilizar ao longo dos primeiros 12 meses 4 .…”

Section: Introductionunclassified

“…A diminuição ponderal, no entanto, tende a se estabilizar ao longo dos primeiros 12 meses 4 . Um reganho de peso de 5 a 10% é esperado a partir de 18 meses, mas o reganho acima de 10% é considerado por alguns autores como clinicamente significativo [3][4][5][6] . O transtorno da compulsão alimentar (TCA) é uma das influências a ser considerada 1,4 .…”

Section: Introductionunclassified

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O transtorno da compulsão alimentar (TCA) tem impacto no reganho de peso após a cirurgia bariátrica? Relato de caso

Mauro

Appolinário

Papelbaum

et al. 2017

J. bras. psiquiatr.

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RESUMOA cirurgia bariátrica (CB) é considerada o tratamento mais eficaz para obesidade grave em longo prazo. Apesar de estar associada à resolução ou melhora das comorbidades clínicas, um desfecho possível é o reganho de peso. Um conjunto de evidências aponta a presença do transtorno da compulsão alimentar (TCA) como um dos fatores de risco associados ao reganho de peso pós-operatório. O objetivo desta apresentação de casos clínicos é discutir o possível impacto dos episódios de compulsão alimentar em pacientes submetidos à CB. Serão apresentados os seguintes casos (1): uma mulher de 41 anos, avaliada após 8 anos da cirurgia, apresentando um reganho de 22,9 kg e psicopatologia alimentar compatível com TCA; (2): um homem de 48 anos, avaliado no pós-operatório de 7 anos, com um reganho de 30 kg e exibindo queixas de beliscamento alimentar, porém sem sintomas compatíveis com TCA; (3): uma mulher de 44 anos, avaliada no pós-operatório de 3 anos, mantendo peso está-vel sem reganho e que exibia à avaliação TCA. Os autores discutem, a partir destes três casos, as evidências relacionadas ao impacto da compulsão alimentar no resultado da CB. Apesar de não haver, no momento, um consenso definitivo quanto ao real impacto dos transtornos alimentares neste recrudescimento ponderal, fica claro que o clínico deve estar atento ao TCA e sua possível associação com o reganho de peso. ABSTRACTBariatric surgery (BS) is the most effectiveness long term treatment to severe obesity. However being associated with resolution or improvement of clinic comorbidities, one possible outcome is weight regain. A group of evidences appoint to the presence of BED (binge eating disorder) as one risk factor associated to post-surgery weight regain. The aim of this case report is to discuss a possible impact of binge eating in patients submitted to BS. The following cases will be presented: (1): 41 years woman, evaluated after 8 years post-surgery, showing weight regain of 22.9 kg and compatible eating psychopathology with BED; (2): 48 years men,

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“…On the one hand, extremely obese patients are at increased cardiovascular risk over their lifespan as a result of chronic metabolic disease. 2 They are also less likely to exercise or to be functionally active, and as such, may not manifest cardiovascular symptoms until the later stages of disease, possibly warranting a high index of suspicion for evaluation. On the other hand, extremely obese patients are also less likely to undergo an evaluation of sufficient diagnostic quality, no matter the imaging modality utilized.…”

mentioning

confidence: 99%

Myocardial perfusion imaging in extreme obesity: Leveraging modern technologies to meet a modern challenge

Taqueti

2019

Journal of Nuclear Cardiology

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Mechanisms, Pathophysiology, and Management of Obesity

Cited by 1,382 publications

References 72 publications

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

O transtorno da compulsão alimentar (TCA) tem impacto no reganho de peso após a cirurgia bariátrica? Relato de caso

Myocardial perfusion imaging in extreme obesity: Leveraging modern technologies to meet a modern challenge

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