Papers by RUTH ROCHA FRANCO
Hormone Research in Paediatrics, 2021
Background/Aims: Obesity leads to increased risk of thromboembolic events in adults, but few stud... more Background/Aims: Obesity leads to increased risk of thromboembolic events in adults, but few studies have addressed the relationship between obesity and thrombogenic risk during childhood. The aim of this study was to evaluate the prothrombotic state of obese children in comparison with healthy children. Methods: Thrombin generation, fibrinogen, and D-dimer levels, along with metabolic parameters, were measured in 72 prepubertal children, of which 47 were obese and 25 eutrophic. Results: A significant increase in thrombin generation, fibrinogen, and dyslipidemia was found among obese patients. Conclusion: A prothrombotic state develops in childhood obesity during the prepubertal phase.
Hormone Research in Paediatrics, 2017
Hormone Research in Paediatrics, 2017
Journal of Sleep Research, 2020
Cardiac death is the second most prevalent cause in Prader‐Willi syndrome (PWS). Paediatric patie... more Cardiac death is the second most prevalent cause in Prader‐Willi syndrome (PWS). Paediatric patients with PWS often present cardiac autonomic dysfunction during wakefulness, obesity and sleep‐disordered breathing. However, the extent of cardiac autonomic modulation during sleep in PWS has not been documented. The objective of this study was to assess alterations in cardiac autonomic modulation of paediatric patients with PWS during different sleep stages. Thirty‐nine participants in three groups: 14 PWS, 13 sex and age‐matched lean controls (LG) and 12 obese‐matched controls (OB). All participants underwent overnight polysomnography, including continuous electrocardiogram recordings. Heart rate variability (HRV) was analysed during representative periods of each sleep stage through time and frequency domains calculated across 5‐min periods. Between‐within ANOVAs were employed (p < .05). The results show that total HRV was lower in PWS than OB and LG during slow‐wave sleep (SWS) (standard deviation of all NN intervals [SDNN] ms, p = .006). Parasympathetic modulation assessed by time‐domain analysis was lower during SWS in PWS compared to both OB and LG (square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD] ms, p = .004; SDSD, standard deviation of differences between adjacent NN intervals [SDSD] ms, p = .02; number of adjacent NN intervals differing by >50 ms [NN50] ms, p = .03; proportion of adjacent NN intervals differing by >50 ms [pNN50] ms, p = .01). Sympathovagal balance assessed by frequency‐domain analysis was lower during both N2 and SWS than during the rapid eye movement (REM) sleep stage, but not different among groups. In conclusion, this group of paediatric patients with PWS had impaired cardiac autonomic balance due to reduced parasympathetic modulation during SWS. This result could imply an underlying increased cardiovascular risk in PWS even during early age and independent of obesity.
Archives of Endocrinology and Metabolism, 2021
Obesity is a complex and multifactorial disease that is influenced by physiological, environmenta... more Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short-and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.
Journal of Pediatric Endocrinology and Metabolism, 2020
Background This study aimed to investigate the presence of sleep disturbances in children with Pr... more Background This study aimed to investigate the presence of sleep disturbances in children with Prader-Willi syndrome (PWS) using the Sleep Disturbance Scale for Children (SDSC). Methods The SDSC, which was designed to identify the presence and severity of different sleep disorders, was applied to 50 patients with PWS and 112 controls. Results Patients with PWS achieved worse scores in the sleep-disordered breathing and disorders in initiating and maintaining sleep in the SDSC questionnaire as compared with controls. We also observed that patients with PWS were more prone to having hyperhidrosis. We did not observe significant differences in the presence of other types of sleep disorders (such as hypersomnolence) between the PWS and control groups. Conclusions The results obtained with the SDSC questionnaire showed that children with PWS have more sleep breathing disorders and disorders in initiating and maintaining sleep as compared to controls. Additionally, we demonstrated that pa...
Brain Sciences, 2016
Obesity is a chronic, progressive and prevalent disorder. Morbid obesity, in particular, is assoc... more Obesity is a chronic, progressive and prevalent disorder. Morbid obesity, in particular, is associated with numerous comorbidities and early mortality. In patients with morbid obesity, pharmacological and behavioral approaches often have limited results. Bariatric surgery is quite effective but is associated with operative failures and a non-negligible incidence of side effects. In the last decades, deep brain stimulation (DBS) has been investigated as a neurosurgical modality to treat various neuropsychiatric disorders. In this article we review the rationale for selecting different brain targets, surgical results and future perspectives for the use of DBS in medically refractory obesity.
e-SPEN Journal, 2013
ABSTRACT Background &amp; aims Few studies have evaluated how well ultrasonographic measureme... more ABSTRACT Background &amp; aims Few studies have evaluated how well ultrasonographic measurements of fat correlate with anthropomorphic measurements and insulin resistance in juveniles. Moreover, the significance of an accumulation of visceral versus subcutaneous fat in obese children and young adults remains controversial. The hypothesis of this study was that ultrasonographic measurements of fat would show better correlations with insulin resistance than with anthropometric measurements. Among the variables associated with insulin resistance, we tried to identify those that had the best correlations with ultrasonographic measurements of fat. Methods Forty-five adolescent volunteers (age range: 10–17 years) were enrolled in this study. Subjects were classified as obese or eutrophic according to their body mass index z-score for Brazilian children and adolescents. Blood samples and anthropometric measurements (waist circumference, waist-to-height ratio, and conicity index) were obtained from all subjects. All patients underwent an ultrasonic assessment of subcutaneous tissue, pre-peritoneal fat, and intra-abdominal fat. Results Ultrasonographic measures of abdominal fat were associated with anthropometric measurements, glucose level, insulin level, and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), with the exception that glucose level was not associated with the maximal pre-peritoneal fat. Body mass index z-score, conicity index, and HOMA-IR remained independently associated with the subjects&#39; total fat in multivariate analysis. Only minimal subcutaneous fat was independently associated with HOMA-IR. Conclusion Subcutaneous fat may be more useful than visceral fat as a marker for insulin resistance in juveniles.
Revista de Odontopediatría Latinoamericana
Objetivo: Avaliar a saúde bucal e o crescimento craniofacial de pacientes pediátricos com Síndr... more Objetivo: Avaliar a saúde bucal e o crescimento craniofacial de pacientes pediátricos com Síndrome de Prader-Willi (SPW), em comparação a crianças obesas não-sindrômicas. Métodos e resultados: Foram selecionadas 40 crianças com SPW e 40 controles não obesos com SPW, com idade de 10,9 anos (controle: 11,89 anos) e IMC 22,72 kg / m2 (controle 36,43 kg / m2). Foram avaliados o número de dentes, tipo de dentição, presença de cárie, sangramento gengival, má oclusão, acúmulo de placa bacteriana, erosão dentária, hiperplasia gengival e hipoplasia do esmalte. Os questionários avaliaram os hábitos de higiene bucal. Radiografias panorâmicas avaliaram o crescimento craniofacial. O grupo caso teve um número 6,8% menor de dentes em comparação ao grupo controle. Observou-se diferença estatisticamente significante no sangramento gengival, erosão dentária e hipoplasia do esmalte (p = 0,009; p = 0,02 ep = 0,006, respectivamente). Não houve diferença estatisticamente significante, observou-se um nú...
Archives of Endocrinology and Metabolism
BMJ Paediatrics Open
BackgroundGrowth hormone (GH) treatment is currently recommended in Prader-Willi syndrome (PWS) p... more BackgroundGrowth hormone (GH) treatment is currently recommended in Prader-Willi syndrome (PWS) patients.ObjectivesTo evaluate the impact (efficacy and safety) of the use of recombinant human GH (rhGH) as a treatment for PWS.MethodWe performed a systematic review and, where possible, meta-analysis for the following outcomes: growth, body mass index, body composition, cognitive function, quality of life, head circumference, motor development/strength, behaviour and adverse effects. We included all PWS patients, with all types of genetic defects and with or without GH deficiency, who participated in rhGH studies performed in infancy, childhood and adolescence, that were either randomised controlled trials (RCTs) (double-blinded or not) or non-randomised controlled trials (NRCTs) (cohort and before and after studies). The databases used were MEDLINE, Embase and Cochrane Central.ResultsIn 16 RCTs and 20 NRCTs selected, the treated group had an improvement in height (1.67 SD scores (SDS)...
Revista Paulista de Pediatria
Objective: To describe a case of a male adolescent with symptomatic idiopathic intracranial hyper... more Objective: To describe a case of a male adolescent with symptomatic idiopathic intracranial hypertension (IIH) associated with obesity treated with bariatric surgery. Case description: A 16-year-and-6-month-old severely obese boy [weight: 133.6 kg; height: 1.74 m (Z score: +0.14); BMI: 44.1 kg/m2 (Z score: +4.4)], Tanner pubertal stage 5, presented biparietal, high-intensity, and pulsatile headaches, about five times per week, associated with nocturnal awakenings, and partial improvement with common analgesics, for three months. Ophthalmologic evaluation evidenced bilateral papilledema. Cranial computed tomography revealed no mass or anatomic abnormalities. Lumbar puncture showed increased intracranial pressure of 40 cmH2O (reference value: <28 cmH2O) with a normal content. After being diagnosed with IIH, the patient was started on acetazolamide. However, after three months, he was still symptomatic. He was diagnosed with obesity due to excess energy intake and, as he had failed ...
Motriz: Revista de Educação Física
The aim of this study was to verify body composition, cardiorespiratory fitness, and biochemical ... more The aim of this study was to verify body composition, cardiorespiratory fitness, and biochemical markers of prepubertal overweight and obese boys to a 16-week futsal training program. Methods: Sixteen boys (age: 7-10 y, body mass index>thanat 95th percentileaccording to Center for Disease Control and Prevention; 35.5±7.4 percent fat) participated to futsal training program. The assessment of body composition was estimated using skinfold thickness, and the following variables were evaluated: total body mass, body mass index, body fat percentage, and lean body mass. Aerobic fitness measurementwas performed by gas exchange analysis in treadmill. In addition, an evaluation of the biochemical profile was conducted: triglycerides, total cholesterol, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, plasma concentrations of glucose, and insulin. The futsal intervention included 60-min sessions performed two times/week. The mean intensity during training was between 57 to 88% of maximal heart rate of the age-predicted. Individual portable heart rate monitor controlled training intensity. Results: Significant increases in total body mass (4%), height (3%), lean body mass (8%), and significant 6%-decrease in body fat percentage was observed. Body mass index remained unchanged. Maximal oxygen uptake was elevated (p<0.018) by 11%. Biochemical markers were not modified after intervention. No association was found between body composition and metabolic variables. The effect size of futsal training on most variables was small (<0.5). Conclusion: Controlled intensity and adherence to this 16-week futsal training program were determinant to enhance body composition, and cardiorespiratory fitness in this group of prepubertal boys.
Revista Paulista de Pediatria
RESUMO Objetivo: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publica... more RESUMO Objetivo: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publicações mais recentes e fornecer recomendações ao pediatra geral para diagnóstico precoce e seguimento. Fonte de dados: Artigos publicados nas bases Pubmed e SciELO. A pesquisa não foi limitada a um período e incluiu todos os artigos das bases de dados. Síntese dos dados: A SPW é uma síndrome genética rara, resultante da perda do imprinting gênico expresso no cromossomo paterno 15q11-q13, sendo caracterizada por alterações endocrinológicas, como deficiência de hormônio de crescimento, obesidade, insuficiência adrenal central, hipotireoidismo, hipogonadismo, além de alterações comportamentais e déficit intelectual. Há outras comorbidades associadas, como distúrbios de sono, escoliose, constipação, problemas dentários e alterações de coagulação. O protocolo de seguimento da SPW do Instituto da Criança da Universidade de São Paulo se baseia em quarto pilares principais: dieta, exercício físico...
Current obesity reports, Jan 8, 2018
The purpose of this study is to present changes of policies and norms aimed to reduce obesity lev... more The purpose of this study is to present changes of policies and norms aimed to reduce obesity levels that have been adopted in some Latin American countries. The global increase of the excess weight within the population has been demanding governmental actions aimed at preventing health impacts generated by obesity. Over recent years, many Latin American countries have established a number of regulations aimed at reducing weight in the population using interventions that could effectively prevent childhood obesity, including the taxation of sugar-sweetened beverages (SSBs), increasing physical activity in open spaces, and, especially, front-of-package labeling. Some strategies are part of the Action Plan for Prevention of Child and Adolescence Obesity signed by all countries in Latin America, which currently have among the highest prevalence of childhood obesity in the world. Among them are the implementation of fiscal policies on energy-dense and nutrient-poor foods and taxes on SS...
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Papers by RUTH ROCHA FRANCO