Multifactorial analysis of changes in body mass index across the adult life course: a study with 65 years of follow-up

Background: Although the negative consequences on health of being obese are well known, most adults gain weight across the lifespan. The general increase in body mass index (BMI) is mainly considered to originate from behavioral and environmental changes; however, few studies have evaluated the influence of these factors on change in BMI in the presence of genetic risk. We aimed to study the influence of multifactorial causes of change in BMI, over 65 years. Methods and Findings: Totally, 6130 participants from TwinGene, who had up to five assessments, and 536 from the Swedish Adoption/Twin Study of Aging, who had up to 12 assessments, ranging over 65 years were included. The influence of lifestyle factors, birth cohort, cardiometabolic diseases and an individual obesity genetic risk score (OGRS) based on 32 single nucleotide polymorphisms on change in BMI was evaluated with a growth model. For both sexes, BMI increased from early adulthood to age of 65 years, after which the increase leveled off; BMI declined after age of 80 years. A higher OGRS, birth after 1925 and cardiometabolic diseases were associated with higher average BMI and a steeper increase in BMI prior to 65 years of age. Among men, few factors were identified that influence BMI trajectories in late life, whereas for women type 2 diabetes mellitus and dementia were associated with a steeper decrease in BMI after the age of 65 years. Conclusions: There are two turning points in BMI in late adulthood, one at the age of 65 years and one at the age 80 years. Factors associated with an increase in BMI in midlife were not associated with an increase in BMI after the age of 65 years. These findings indicate that the causes and consequences of change in BMI differ across the lifespan. Current health recommendations need to be adjusted accordingly.

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5���22.7) and 16.5 cm (13.3��� 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8��� 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Asociaci��n entre la escala de riesgo Framingham y el puntaje de calcio coronario

Introducci��n: Entre las diferentes herramientas cl��nicas para evaluar la presencia de enfermedad coronaria mediante puntajes, la m��s usada es la Escala de Riesgo cardiovascular de Framingham. Desde hace unos a��os, se cre�� el puntaje de calcio coronario el cual mide el riesgo cardiovascular seg��n la presencia de placas ateromatosas vistas por tomograf��a computarizada. Se evalu�� la asociaci��n entre la escala de Framigham y el puntaje de calcio coronario en una poblaci��n de sujetos sanos asintom��ticos. Metodolog��a: Se realiz�� un estudio transversal para evaluar la asociaci��n entre el puntaje de calcio coronario y la escala de Framingham en sujetos asintom��ticos que se practicaron ex��men m��dico preventivo en la Fundaci��n Cardioinfantil- Instituto de Cardiolog��a (FCI-IC) en el periodo comprendido entre 1 de Julio 2011 hasta el 31 de octubre de 2015. Resultados: Se evaluaron 262 pacientes en total. La prevalencia de riesgo cardiovascular fue bajo en un 77.86% de la poblaci��n, medio en 18.70% y alto en 3.44%, seg��n la escala de Framingham. El riesgo cardiovascular seg��n el puntaje de Calcio coronario fue nulo 70.99%, bajo en 21.75%, medio en 4.19%, severo en 3.05%. Se encontr�� una asociaci��n entre ambos puntajes para riesgo estad��sticamente significativa (p0,00001) Discusi��n: El riesgo cardiovascular establecido por escala de Framingham se relaciona de forma significativa con la presencia de placas aterioscler��ticas. El estudio demostr�� que en una muestra de sujetos asintom��ticos, hay una alteraci��n estructural coronaria temprana.

Evidencia sobre la eficacia de cannabinoides en el dolor neurop��tico oncol��gico

Contexto: La eficacia de los cannabinoides en el dolor neurop��tico es desconocida. El control del dolor es determinante en los pacientes ya que genera un impacto negativo en la calidad de vida de los pacientes. Objetivo: El presente trabajo pretende demostrar la evidencia sobre la eficacia de los medicamentos cannabinoides en el control del dolor neurop��tico oncol��gico, mediante la evaluaci��n de la literatura disponible. Metodolog��a: Se realiz�� una revisi��n sistem��tica de literatura incluyendo estudios experimentales, observacionales y revisiones sistem��ticas en un periodo de 15 a��os. Se incluyeron todos los estudios desde el a��os 2000 con evidencia IB seg��n la escala de evidencia de Oxford. Resultados: Cuatro estudios cumplieron criterios para su inclusi��n, sin embargo la evidencia es baja y no permite recomendar o descartar los cannabinoides como terapia coadyuvante en control del dolor neurop��tico oncol��gico. La combinaci��n de THC/CDB (Sativex��) parece ser un medicamento seguro pues no se reportaron muertes asociadas a su uso, sin embargo la presentaci��n de eventos adversos a nivel gastrointestinal y neurol��gico podr��a aumentar el riesgo de interacciones medicamentosas y tener un impacto negativo en la calidad de vida de los pacientes oncol��gicos. Conclusiones: No hay suficiente literatura y la evidencia no es suficiente para recomendar o descartar el uso de los cannabinoides en dolor neurop��tico oncol��gico. Futuros estudios deben realizarse para analizar el beneficio de estos medicamentos. Aunque ��tica y socialmente hay resistencia para el uso de los cannabinoides, actualmente hay una gran discusi��n pol��tica en el mundo y en Colombia para su aceptaci��n como terapia en el control del dolor.

Percentiles de la prueba de carrera de ida y vuelta 4x10 m en escolares de 9 a 17 a��os de Bogot��, Colombia: Estudio FUPRECOL

Objetivo: Este estudio describe los percentiles de la prueba de carrera de ida y vuelta 4 x 10 m en escolares de 9 a 17 a��os, de Bogot��, Colombia, pertenecientes al estudio Asociaci��n de la fuerza prensil con manifestaciones tempranas de riesgo cardiovascular en ni��os colombianos. ���FUPRECOL��� M��todos: Estudio descriptivo transversal, en 2502 varones (42.7%) y 3349 mujeres (57,2%), de edades entre 9 y 17 a��os, pertenecientes a 24 instituciones educativas del sector oficial, en Bogot��, Colombia. La velocidad/agilidad se evalu�� con la prueba de carrera de ida y vuelta 4 x 10 m (componente motor de la bater��a Fuprecol). Se calcularon los percentiles (P3, P10, P25, P50, P75, P90 y P97) y curvas centiles por el m��todo LMS, seg��n el sexo y la edad; y se realiz�� una comparaci��n entre los valores de la velocidad-agilidad observados con estudios internacionales. Resultados: La edad promedio de los participantes fue 12,7 (DE 2,4) a��os. Al comparar por sexos, los varones presentan un mejor rendimiento en la prueba de carrera 4 x 10 m que las mujeres. En varones, el P50 oscil�� entre 11,9 segundos y 13,1 segundos, mientras que en mujeres el P50 oscil�� entre 14,3 segundos y 15,0 segundos. Al comparar los resultados de este estudio por grupos de edades y sexos, con trabajos internacionales, el P50 fue mayor al reportado en los trabajos de Espa��a, Portugal y el estudio HELENA realizado en 9 pa��ses europeos. Esta misma tendencia fue observada al comparar la media y la desviaci��n est��ndar con escolares de Argentina, Francia y el mismo estudio HELENA. Conclusiones: Se registran percentiles de la prueba de carrera de ida y vuelta 4 x 10 m en funci��n de las edades y el sexo. Estos valores pueden ser utilizados tanto para evaluar los niveles de aptitud de los estudiantes como para detectar a estudiantes cuyos niveles de condici��n f��sica est��n por debajo de un m��nimo saludable.

Factores asociados a transfusi��n sangu��nea en el manejo quir��rgico del canal lumbar estrecho en la Fundaci��n Santa Fe de Bogot�� 2003 - 2013

Introduccion: El canal lumbar estrecho es un motivo de consulta frecuente en el servicio de columna de la Fundaci��n Santa Fe de Bogot��. Derivado del tratamiento quirurgico se pueden generar m��ltiples complicaciones, entre las que se encuentra la transfusi��n sangu��nea. Objetivo: Identificar los factores sociodemogr��ficos, antecedentes personales y factores quir��rgicos asociados a transfusi��n sangu��nea en cirug��a canal lumbar estrecho en la Fundaci��n Santa Fe de Bogot�� 2003- 2013. Materiales y m��todos: Se aplic�� en dise��o de estudio observacional anal��tico transversal. Se incluyeron 367 pacientes sometidos a cirug��a de canal lumbar estrecho a quienes se les analizaron variables de antecedentes personales, caracter��sticas sociodemograficas y factores quir��rgicos. Resultados: La mediana de la edad fue de 57 a��os y la mayor��a de pacientes fueron mujeres (55,6%). La mediana del ��ndice de Masa Corporal (IMC) fue de 24,9 clasificado como normal. Entre los antecedentes patol��gicos, la hipertensi��n arterial fue el m��s com��n (37,3%). La mayor��a de pacientes (59,1%) presentaron clasificaci��n ASA de II. El tipo de cirug��a m��s prevalente fue el de descompresi��n (55,6%). En el 79,8% de los pacientes se intervinieron 2 niveles. Se realiz�� transfusi��n de gl��bulos rojos en 26 pacientes correspondiente a 7,1% del total. En la mayor��a de procedimientos quir��rgicos (42,5%) el sangrado fue clasificado como moderado (50-500 ml). En el modelo explicativo transfusi��n sangu��nea en cirug��a de canal lumbar estrecho se incluyen: antecedente de cardiopat��a (OR 4,68, P 0,034, IC 1,12 ��� 19,44), Sangrado intraoperatorio >500ml (OR 6,74, p 0,001, 2,09 ��� 21,74) y >2 niveles intervenidos (OR 3,97, p 0,023, IC 1,20 ��� 13,09). Conclusi��n: Como factores asociados a la transfusi��n sangu��nea en el manejo quir��rgico del canal lumbar estrecho a partir de la experiencia de 10 a��os en la Fundaci��n Santa Fe de Bogot�� se encontraron: enfermedad cardiaca, sangrado intraoperatorio mayor de 500ml y m��s de dos niveles intervenidos.

Epileptic and developmental encephalopathies: clinical and genetic study of adult patients attending a tertiary Epilepsy Centre

Objectives: To fully re-evaluate patients with early-onset epilepsy and intellectual disability with neurological, neurophysiological and neuropsychological examination in order to contribute to expanding the phenotypic spectrum of known epileptic encephalopathy (EE)-related genes and to identify novel genetic defects underlying EEs. Methods: We recruited patients with epilepsy and intellectual disability (ID) referring to our Epilepsy Centre. Patients underwent full clinical and neurophysiologic evaluation. When possible they underwent neuroradiologic investigations. Selected cases also underwent genetic analysis. Results: We recruited 200 patients (109 M, 91 F; mean age 36 years old). Mean age at epilepsy onset was 4 years old. The degree of ID was borderline in 4.5% of patients, mild in 25%, moderate in 38% and severe in 32.5%. EEG showed epileptiform abnormalities in 79.5% of patients. One hundred and thirty-one patients out of the 200 recruited (65.5%) did not have an aetiological diagnosis. All the patients underwent full clinical reassessment and when necessary they performed neuroradiologic and genetic investigations as well. We identified 35 patients with a genetic aetiology. In 8 cases a structural brain lesion was observed. In 33 patients, a genetic aetiology was identified. In 2 patients with drug-resistant seizures video-EEG allowed the identification of non-epileptic seizures, and in one patient we discontinued anti-epileptic drugs. In these patients, the aetiological diagnosis was made after 30 years (range 9-60 years) from the disease onset. Conclusions: In a population of 200 adult patients with epilepsy and ID, an aetiological cause was identified in 45 patients after 30 years from the disease onset. Aetiological diagnosis, especially if genetic, has significant positive implications for patients, even if it has been made after years from the beginning of the disease. Benefits include better-focused antiepileptic drug (AED) choice, sparing of further unnecessary investigations and improved knowledge of comorbidities.

Obesit�� infantile: abitudini alimentari e stili di vita delle famiglie. Un'analisi sociologica sul territorio riminese

L'obesit�� infantile pu�� essere considerata una delle maggiori sfide sanitarie del XXI secolo. In Italia, la fascia d'et�� pi�� colpita �� quella tra i 6 e gli 11 anni. L'infanzia e l'adolescenza non solo influenzano lo sviluppo fisico, cognitivo e sociale dell'adulto, ma anche l'aspettativa di vita. Inoltre, l'interruzione dell'insegnamento in classe e le misure di contenimento di Covid-19 hanno aumentato il comfort food, la sedentariet�� e la vulnerabilit�� socio-economica delle famiglie. Lo scopo del lavoro di ricerca �� stato quello di studiare i fattori sociali che hanno influenzato le abitudini alimentari e gli stili di vita delle famiglie con bambini di et�� compresa tra i 6 e gli 11 anni, all'interno dell'ambiente di socializzazione primario (famiglia) e secondario (scuola e altre istituzioni) anche durante la pandemia di COVID-19. La ricerca �� stata condotta in Emilia-Romagna nella citt�� di Rimini e poi estesa al contesto europeo contemporaneo. Per indagare questo punto, �� stata utilizzata una metodologia in parte qualitativa e in parte quantitativa. L'approccio mosaico composto da 15 interviste semi-strutturate; 8 focus group e 5 etnografie ha permesso di costruire un questionario, online e cartaceo, somministrato a 361 genitori. I principali risultati rivelano che (1) i bambini sono ingrassati durante il periodo di Covid; (2) esiste una correlazione tra il peso della madre e il peso del bambino; (3) le madri sottovalutano l'obesit�� dei figli.

Malignant Transformation Of An Odontogenic Cyst In A Period Of 10 Years.

Primary intraosseous carcinoma of the jaws (PIOSCC) might arise from odontogenic epithelium, more commonly from a previous odontogenic cyst. The aim of this case is to illustrate that the clinician should consider that an apparent benign dentigerous cyst can suffer malignant transformation and that all material removed from a patient must be evaluated histologically. A 44-year-old man presented in a routine periapical X-ray an impacted lower left third molar with radiolucency over its crown. Ten years later, the patient complained of pain in the same region and the tooth was extracted. After one month, the patient still complained of pain and suffered a fracture of the mandible. A biopsy was performed and carcinoma was diagnosed. The patient was treated surgically with adjuvant radio- and chemotherapy and after 8 years, he is well without signs of recurrences. This report describes a central mandibular carcinoma probably developed from a previous dentigerous cyst.

Hepatic Involvement In Paediatric Patients With Paracoccidioidomycosis: A Histological Study.

Paracoccidioidomycosis is a systemic mycosis that is endemic to certain countries in Latin America. This study aimed to describe the histological features of liver involvement in patients with paracoccidioidomycosis aged <16 years of age who were treated between 1980 and 2010, with a diagnosis that was confirmed by detection of the fungus by pathological examination. Liver tissue was obtained from one necropsy and 12 biopsies. Throughout 2007, biopsies were taken from patients with persistent jaundice or portal hypertension, after which biopsies became indicated due to elevated aminotransferase and low albumin levels. Using haematoxylin and eosin (H&E), Masson's trichrome and immunohistochemical (CK7 and CK19) staining, we noted degenerative alterations in bile duct cells and inflammatory injury to the bile ducts in 10 biopsies. Using immunohistochemistry for CK7 and CK19, we observed ductal proliferation in all 12 samples. Bile duct injuries by inflammatory cells might explain the predominant increase in canalicular enzymes; immunohistochemistry is more sensitive in demonstrating ductular reactions and might show changes that are not apparent on H&E staining.

Mucopolysaccharidosis Type Ii: Identification Of 30 Novel Mutations Among Latin American Patients.

In this study, 103 unrelated South-American patients with mucopolysaccharidosis type II (MPS II) were investigated aiming at the identification of iduronate-2-sulfatase (IDS) disease causing mutations and the possibility of some insights on the genotype-phenotype correlation The strategy used for genotyping involved the identification of the previously reported inversion/disruption of the IDS gene by PCR and screening for other mutations by PCR/SSCP. The exons with altered mobility on SSCP were sequenced, as well as all the exons of patients with no SSCP alteration. By using this strategy, we were able to find the pathogenic mutation in all patients. Alterations such as inversion/disruption and partial/total deletions of the IDS gene were found in 20/103 (19%) patients. Small insertions/deletions/indels (<22 bp) and point mutations were identified in 83/103 (88%) patients, including 30 novel mutations; except for a higher frequency of small duplications in relation to small deletions, the frequencies of major and minor alterations found in our sample are in accordance with those described in the literature.

Long-term Postoperative Atrophy Of Contralateral Hippocampus And Cognitive Function In Unilateral Refractory Mtle With Unilateral Hippocampal Sclerosis.

This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (�� 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.

Exploratory Study Of The Effect Of Lifestyle Counselling On Bone Mineral Density And Body Composition In Users Of The Contraceptive Depot-medroxyprogesterone Acetate.

To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Student's t-test followed by multiple linear regression analysis. Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ��� 1 g/day compared to DMPA users with a lower calcium intake. DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ��� 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims.

Longitudinal Analysis Of Hippocampal T2 Relaxometry In Fmtle.

To investigate the degree of T2 relaxometry changes over time in groups of patients with familial mesial temporal lobe epilepsy (FMTLE) and asymptomatic relatives. We conducted both cross-sectional and longitudinal analyses of T2 relaxometry with Aftervoxel, an in-house software for medical image visualization. The cross-sectional study included 35 subjects (26 with FMTLE and 9 asymptomatic relatives) and 40 controls; the longitudinal study was composed of 30 subjects (21 with FMTLE and 9 asymptomatic relatives; the mean time interval of MRIs was 4.4 �� 1.5 years) and 16 controls. To increase the size of our groups of patients and relatives, we combined data acquired in 2 scanners (2T and 3T) and obtained z-scores using their respective controls. General linear model on SPSS21�� was used for statistical analysis. In the cross-sectional analysis, elevated T2 relaxometry was identified for subjects with seizures and intermediate values for asymptomatic relatives compared to controls. Subjects with MRI signs of hippocampal sclerosis presented elevated T2 relaxometry in the ipsilateral hippocampus, while patients and asymptomatic relatives with normal MRI presented elevated T2 values in the right hippocampus. The longitudinal analysis revealed a significant increase in T2 relaxometry for the ipsilateral hippocampus exclusively in patients with seizures. The longitudinal increase of T2 signal in patients with seizures suggests the existence of an interaction between ongoing seizures and the underlying pathology, causing progressive damage to the hippocampus. The identification of elevated T2 relaxometry in asymptomatic relatives and in patients with normal MRI suggests that genetic factors may be involved in the development of some mild hippocampal abnormalities in FMTLE.

[food Insecurity In Brazilian Families With Children Under Five Years Of Age].

This article analyzes food insecurity and hunger in Brazilian families with children under five years of age. This was a nationally representative cross-sectional study using data from the National Demographic and Health Survey on Women and Children (PNDS-2006), in which the outcome variable was moderate to severe food insecurity, measured by the Brazilian Food Insecurity Scale (EBIA). Prevalence estimates and prevalence ratios were generated with 95% confidence intervals. The results showed a high prevalence of moderate to severe food insecurity, concentrated in the North and Northeast regions (30.7%), in economic classes D and E (34%), and in beneficiaries of conditional cash transfer programs (36.5%). Multivariate analysis showed that the socioeconomic relative risks (beneficiaries of conditional cash transfers), regional relative risks (North and Northeast regions), and economic relative risks (classes D and E) were 1.8, 2.0 and 2.4, respectively. Aggregation of the three risks showed 48% of families with moderate to severe food insecurity, meaning that adults and children were going hungry during the three months preceding the survey.