The assessment of weight status is important in many epidemiological studies, but its direct measurement is not always possible. Self-reported weight and height are often used, although previous research reported low accuracy. This study aimed to test the ability of trained observers to accurately estimate weight status in adults using structured observation. A cross-sectional study was conducted. For each participant, height and weight were estimated in categories, and weight status was recorded using Stunkard’s body figures, by two trained observers. Height and weight were also measured, using standardized procedures. Subjects were classified according to World Health Organization body mass index (BMI) cut-offs from objective measurements and from the BMI assigned to each body figure. Sensitivity, specificity, and likelihood ratios were calculated to assess the accuracy of estimating weight status by observation. Kappa was used to test inter-observer reliability. A total of 127 participants were assessed, 70 women and 57 men, aged between 19 and 89 years (mean ± standard deviation: 50.3 ± 16.3 years). Most participants were overweight or obese (64.3% women; 78.9% men). The sensitivity and specificity of overweight/obesity status identification were 72.8% and 78.4%, respectively. Observers’ gender, participants’ gender, and participants’ age were significantly associated with the estimation of overweight/obesity. The agreement between observers was moderate for BMI estimates (κ = 0.52) but substantial when distinguishing normal weight from overweight/obesity (κ = 0.67). Trained observers were able to distinguish normal weight from overweight/obesity with high sensitivity and specificity, and substantial interrater reliability. This innovative methodology showed potential for improvement through enhanced training techniques. The use of structured observation may be a useful and accurate alternative to self-reported weight status assessment, whenever anthropometric measurement is not achievable.

Introduction: This study aimed to compare the results of a conservative method and the Sleeve Gastrectomy procedure for weight loss on the cognitive-emotional performance of severely obese women assessed for Obstructive Sleep Apnoea Syndrome. Material and methods: Two samples consisting of females, approved for Sleeve Gastrectomy (n = 21) and Conservative Treatment (n = 21) underwent night polysomnography and completed a battery of neuropsychological and emotional tests before and 6 months after the interventions. We compared intra- and inter-sample results, post interventions result to controls, and treated patients with Obstructive Sleep Apnoea Syndrome. Results: Anthropometry, immediate memory, attention, executive functions, and emotional maladjustment improved after the interventions. The conservative method showed better results for inhibitory control, and surgery showed better results for cognitive flexibility, speed of information processing and general cognitive and emotional performance for women with Obstructive Sleep Apnoea Syndrome. Learning decreased following both interventions. Memory and cognitive flexibility were lower in the comparison group than in control groups. Discussion: Treatments impacted different cognitive domains with probable influence on the objectives achieved. Lower middle pressure for behaviour modification may have reduced learning after interventions. The reduction of depression/anxiety in women with Obstructive Sleep Apnoea may result from the improvement of the social effects of both conditions. Although with better results for the surgical method, anthropometric reductions in both methods, positively influenced the cognitive/emotional domains. The maintenance of cognitive weaknesses implies longer and more focused interventions to avoid the regression of results like the worsening of Obstructive Sleep Apnoea Syndrome.

Objective Obstructive sleep apnoea (OSA) is the most common sleep disorder and its prevalence has increased with the obesity pandemic. We aimed to explore the presence of OSA in severe obesity and to evaluate the association of body mass index (BMI) with sleep architecture, cognition, emotional distress and comorbidities in OSA versus non-OSA patients. Methods A sample of 61 patients performed a neuropsychological battery that included tasks of attention, memory, perceptual/visuospatial ability, vocabulary, inhibition, cognitive flexibility and distress symptomatology, before overnight polysomnography. Results More than half of the sample had OSA. Excessive daytime sleepiness was not a prominent complaint. Sleep architecture was worse in the OSA than in the non-OSA group, and hypertension was increased with OSA, especially in the severe OSA group. A higher BMI was associated with cognitive distress and sleep variables and with type 2 diabetes. The apnoea-hypopnoea index (AHI) was correlated with gender and cognitive measurements. Cognitive complaints were associated with enhanced distress in both OSA and non-OSA patients. Discussion OSA is considerably present in severely obese patients. The BMI was strongly associated with other important anthropometric measurements along with worsening sleep architecture and lower executive functioning, both of which may contribute to weight gain. The AHI was significantly higher in men and affected memory and maintaining sets on the Wisconsin Card Sorting Test which may represent a barrier to treatment adherence for this disorder. The substantial presence of cognitive complaints in OSA and non-OSA patients suggests the need for psychological intervention focused on adaptive coping strategies, mostly for depressive symptoms. Given the current obesity epidemic, these results support the need for routine sleep investigation in obese people, particularly in primary care settings. BMI, neuropsychological and emotional screening can provide crucial information about asymptomatic and high-risk patients who require prompt sleep intervention and obesity treatment.

Introduction: Obesity is a significant risk factor for multiple comorbidities, and its relation to neurocognitive disfunction is particularly important in cognitive decline, especially in middle age. Due to their impact on neurodegeneration, we sought to explore neuropsychological profile, cognitive reserve and emotional distress in patients with severe obesity.Material and Methods: We used a sociodemographic and clinical questionnaire, neuropsychological tests and a symptom self-reported scale of emotional distress. We evaluated the cognitive performance of 120 patients, aged between 18 and 65 years, in treatment for their severe obesity in Portugal, between May 2012 and December 2015.Results: Cognitive performance was below the mean for the Portuguese population, for immediate recall, visuoperception, resistance to interference and cognitive flexibility. Cognitive reserve was mostly low, especially in the older groups and groups with low professional status and increased associated with better cognitive outcomes. Emotional distress was shown to be higher in our sample compared with a normative sample. The risk factors evaluated were important in the worsening of cognitive functions. Cognitive performance decreased with age.Discussion: Severe obesity was associated with a poorer cognitive performance of the sample. The cognitive reserve was greater in the younger groups. There was a significant presence of emotional distress, especially among women.Conclusion: Severe obesity is associated with an impairment in cognitive and emotional performance, aggravated by aging, cognitive reserve, and comorbidity. This study emphasizes the need for preventive actions, such as neuropsychological screening, in the detection of changes and the design of better interventions.

In patients with type 2 diabetes mellitus, depressive symptoms may be associated with metabolic deterioration. The impact of sex on this association is unclear. The aim of this study is to analyze the relationship between depression and metabolic control by sex. The data presented is the side product of the clinical investigation by Rui Duarte, MD, Treatment Response in Type 2 Diabetes Patients with Major Depression from 2007.

We examined the presence of the Obstructive Sleep Apnea Syndrome (OSAS) and explored associations/correlations between sleep variables, anthropometric measures, cognitive performance, and psychological distress in severely obese patients. We also sought to verify the relationship between the Cognitive Reserve (CR) and the OSAS. Sixty-one patients who required treatment for severe obesity performed a neuropsychological evaluation and an overnight polysomnography. Most of the patients were female in the age group of 50 years. The incidence of the OSAS defined by Apnea-Hypopnea Index (AHI) was 65.6%. The Severe Apnea group was the biggest, with a statistically significant number of males, significantly higher anthropometric measures, and with a higher percentage of patients with low CR than the other groups. Cognitive performance was significantly affected by sleep parameters, sleep efficiency and REM sleep duration. Great daytime sleepiness and cognitive complaints were correlated with distress symptoms. The female gender, advanced age, the highest weight, daytime sleepiness, hypertension, and oxygen saturation significantly contributed to the onset of the OSAS. The incidence of the OSAS is higher in severely obese patients. Anthropometric measures, cognitive performance, and psychological distress symptoms are influenced by sleep parameters and sleep efficiency. There is a high percentage of patients with Severe Apnea and low CR.

Bariatric surgery is recognized as the most effective method for achieving relevant weight loss in subjects with severe obesity. However, there is insufficient knowledge about weight self-regulation and quality of motivation in these patients. The main goal of this study was to characterize the association between the percentage of excess weight loss (%EWL) and the motivation to manage weight, at least 1 year after sleeve gastrectomy (SG). This is an observational longitudinal retrospective study. All patients corresponding to predefined inclusion criteria who underwent SG from January 2008 to July 2010 at a main general hospital were invited. A version of the Treatment Self-Regulation Questionnaire (TSRQ) was used to assess patients’ quality of motivation: TSRQ concerning continuing the weight self-management program. Clinical data were collected from patients’ records. Overall, 81 patients participated (16 men and 65 women, 25-64 years old). The average body mass index was significantly reduced from 45.3 ± 7.0 kg/m2 preoperatively to 32.7 ± 6.9 kg/m2 postoperatively. Autonomous self-regulation was higher than externally controlled self-regulation, regarding motives to keep managing weight after SG. Postoperatively, %EWL correlated negatively with external self-regulation. SG was found to be associated with the quality of motivation for losing weight. External motivations were associated with worse results. These findings support the importance of multiprofessional teams in the assessment and treatment of patients, aiming for the promotion of weight self-regulation after bariatric surgery.

Obesity is recognised as a serious public health issue, due to its associated morbidity and mortality. This study aimed at estimating the prevalence of overweight and obesity in the Portuguese population through direct measurements obtained by the 1st National Health Examination Survey (INSEF 2015) and to identify its associated sociodemographic factors. INSEF was a nationally representative cross-sectional prevalence study conducted on 4911 Portuguese adults aged 25-74 years, in 2015. Height and weight were measured according to the European Health Examination Survey procedures. Poisson regression was used to estimate the adjusted prevalence ratios of overweight and obesity according to age, marital status, occupational activity, education, urbanization of living area and smoking status. Overall prevalences of overweight and obesity were 39.1% and 28.6%, respectively. The prevalence of overweight was higher among men (45.5% vs 33.2%) while the prevalence of obesity was higher among women (32% vs 25%). The sociodemographic factors associated with overweight and obesity were age, marital status and education. Smoking status was associated with overweight and obesity but only in women. INSEF suggests that a high prevalences of overweight and obesity are found in older individuals, married, with lower education levels and non-smoking women. Public health interventions are urgently required for obesity prevention, namely throughout health literacy strategies.

BACKGROUND:Cancer screening has contributed to downward trends in cancer mortality, but is also associated with adverse effects, which highlights the importance of promoting the participation based on informed decisions.OBJECTIVES:We aimed to describe the use of cancer screening (either in organized programmes or as opportunistic screening), awareness of organized programmes and perception of its potential benefits and adverse effects, depicting possible sex differences.DESIGN AND METHODS:We evaluated 1624 Portuguese-speaking dwellers, aged between 16 and 79 years, through face-to-face interviews. To quantify sex differences, adjusted prevalence ratios and respective 95% confidence intervals were computed using Poisson regression.RESULTS:Among eligible age groups, the lifetime prevalence of screening for breast and cervical cancers was 89.8 and 71.9%, respectively. The prevalence was 23.7% for colorectal cancer and no significant sex differences were observed. Prostate cancer screening was reported by 63.8% of men. Over half of the participants referred that cancers such as prostate, skin, lung and stomach should be screened for, in addition to those for which organized programmes are recommended. Reassurance by negative results was identified as the main potential benefit of screening by nearly one-third of men and women. Anxiety while waiting for results was the most mentioned potential adverse effect (60.4%); men refer less often this and financial costs, although statistical significance of these results was borderline.CONCLUSIONS:This study provides a benchmark to plan and monitor the effects of awareness-raising interventions, as well as for international comparisons across countries with different cancer prevention and control structures.

Background: Preoperative nutritional counseling provides an opportunity to ameliorate patients' clinical condition and build-up adequate habits and perception of competence. Study aimed to evaluate: (a) the effect of INDIVIDUO on weight and metabolic control; (b) the impact of INDIVIDUO on psychosocial variables associated with successful weight-control.Methods: Two-arms randomised controlled single-site study, with six-month duration. Patients were recruited from an Obesity Treatment Unit's waiting list. For the intervention group (IG), an operating procedure manual was used, nutritionists received training/supervision regarding INDIVIDUO's procedures. Control group (CG) received health literacy-promoting intervention. Intention-to-treat and per-control analysis were used. Outcomes included weight, metabolic control variables (blood pressure, glycemia, insulinemia, triglycerides, cholesterol), measures of eating and physical activity patterns, hedonic hunger, autonomous/controlled regulation, perceived competence for diet (PCS-diet) and quality of life. Primary outcomes were weight and metabolic control. Effect size was estimated by odds ratio and Cohens'd coefficient.Results: Overall, 94 patients participated (IG: 45; CG: 49) and 60 completed the study( IG: 29; CG: 31). Intervention patients lost an excess 9.68% body weight (%EWL), vs. 0.51% for CG. Adjusting for age and baseline BMI, allocation group remained an independent predictor of % EWL (B = 8.43, 95% CI: 2.79-14.06). IG had a six-fold higher-probability (OR: 6.35, 95% CI: 1.28-31.56) of having adequate/ controlled fastingglycemia final evaluation. PCS-diet at final evaluation was independently predictedby baseline PCS-diet (B = 0.31, 95% CI: 0.06-0.64), variation in autonomous regulation( B = 0.43, 95% CI: 0.15-0.71) and allocation group (B = 0.26, 95% CI: 0.04-1.36).Conclusions: Results on weight and metabolic control support INDIVIDUO as a valuable clinical tool for obesity surgery candidates counseling. Additionally, interventionassociated with perceived competence for weight-control behaviours and autonomousregulation. (C) 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Several studies have suggested that dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) may enhance working memory and attention, yet current evidence is still inconclusive. The balance between both forms of the hormone might be crucial regarding the effects that DHEA and DHEAS exert on the central nervous system. To test the hypothesis that higher DHEAS-to-DHEA ratios might enhance working memory and/or involuntary attention, we studied the DHEAS-to-DHEA ratio in relation to involuntary attention and working memory processing by recording the electroencephalogram of 22 young women while performing a working memory load task and a task without working memory load in an audio-visual oddball paradigm. DHEA and DHEAS were measured in saliva before each task. We found that a higher DHEAS-to-DHEA ratio was related to enhanced auditory novelty-P3 amplitudes during performance of the working memory task, indicating an increased processing of the distracter, while on the other hand there was no difference in the processing of the visual target. These results suggest that the balance between DHEAS and DHEA levels modulates involuntary attention during the performance of a task with cognitive load without interfering with the processing of the task-relevant visual stimulus.

Introduction: Bariatric surgery is an effective treatment for morbid obesity and several comorbidities, including Metabolic Syndrome (MS). Among the described techniques, gastric bypass is a well validated surgical procedure, while vertical gastrectomy as standalone procedure, is more recent but has already showed to provide equally satisfying results regarding weight loss and comorbidities improvement. Our aim was to compare the two procedures regarding weight loss and MS remission criteria.Methods: This prospective study included obese patients with MS submitted to vertical gastrectomy (n = 48) or gastric bypass (n=121), which were compared regarding weight loss and MS criteria for 24 months after surgery.Results: The percentage of excess body mass index lost and MS remission rate after the surgery were similar in both groups after 24 months. However, in the first year after surgery, patients submitted to gastric bypass presented a significantly lower body mass index (BMI) and higher percentage of excess BMI lost while patients submitted to vertical gastrectomy showed a higher MS remission rate. Noticeably, before surgery, fasting glucose and anti-diabetic drug use were significantly higher in the gastric bypass group compared to the sleeve gastrectomy group, a difference that disappeared after the surgery. There were no statistically significant differences regarding major surgical complications between the groups.Conclusion: Vertical gastrectomy and gastric bypass were equally effective and safe in terms of weight loss and MS remission in obese patients. The distinctive improvement in the glycemic profile after gastric bypass, suggests the possible existence of a specific anti-diabetic effect associated with the procedure. (C) 2015 Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A obesidade pode ser uma das caracteristicas mais alteraveis no processo de migracao. Pretendeu-se resumir a informacao sobre o impacto da migracao no indice de massa corporal (IMC). Realizou-se uma revisao sistematica da literatura de acordo com as diretrizes PRISMA, por meio de pesquisa eletronica (ultima atualizacao em agosto de 2014). Foram incluidos e avaliados qualitativamente 39 artigos. A associacao entre migracao e evolucao de IMC varia de acordo com o grupo etnico e paises de origem/acolhimento. Imigrantes hispânicos, europeus e africanos apresentam relacao consistente e positiva entre IMC e tempo de migracao. Os imigrantes asiaticos apresentam associacao positiva em menos da metade dos estudos. No geral, a qualidade dos estudos e fraca e ha necessidade de melhorar conceitos e metodos. Parece existir um efeito deteriorativo da migracao no IMC. Alteracoes nutricionais, de atividade fisica, fatores psicossociais e suscetibilidade genetica podem ser motivos subjacentes a incluir como variaveis moderadoras em estudos futuros.

Avaliou‐se, pela primeira vez, a prevalência de excesso de peso em imigrantes brasileiros e africanos em Portugal. Foram selecionados imigrantes adultos de primeira geração por amostragem aleatória espacial. Os dados foram recolhidos em 2007. A amostra incluiu 1.777 imigrantes (adesão: 97,9%) (37,8% brasileiros; 53,5% mulheres). A pré‐obesidade nos brasileiros foi de 28,0% nas mulheres e 30,9% nos homens; em africanos 32,8 e 36,0%, respetivamente. Na obesidade foi 7,1 e 7,8% (brasileiros) e 17,8 e 9,1% (africanos). O índice de massa corporal varia com: idade, estado civil, anos desde migração e naturalidade. Importa monitorizar os indicadores de saúde deste grupo de modo a delinear estratégias de intervenção.

To the Editors, I read the systematic review The Impact of Migration on Body Weight: A Review published in the February 2015 issue 1. While the subject of this review is relevant to the global issue of obesity, there are significant concerns in the presentation of the findings by Goulão et al. In lieu of the limited number of studies on immigration and obesity in some ethnic groups, the authors should have expanded their review to include other databases such as EMBASE and the Cochrane Reviews, conference proceedings, and national surveys for those ethnic groups where limited studies were reported. Through the EMBASE database search, five out of 13 studies were relevant using the search terms immigrant, obesity, acculturation, and Latino (citations provided upon request). The literature search should have been inclusive of ethnic-specific terms as additional studies were found relevant to this review. There were significant limitations in the authors’ presentation of Hispanics immigrants of various ethnic origins (Central and South Americans), considering the increasing diversity in developing countries 2. African Caribbean immigrants were not adequately highlighted in this systematic review despite the increasing prevalence of obesity evidenced by the large number of published studies 3,4. It is commendable that Goulão et al. tried to address a very important topic such as migration and its associated racial and ethnic differences contributing to the prevalence of obesity in adult migrants. The authors addressed diet, physical inactivity, cultural values, and religion, very relevant factors in the context of migration. The authors also described the methodological limitations encountered by ethnic groups and summarized mediators of health status in migrants. Social factors, including marital and socioeconomic status, are important factors that need to be considered in the study of racial and ethnic group differences associated with migrants’ increasing weight status 5,6. Acculturation scales inclusive of indicators such as primary language and length of residence in migrating country should also be conCaRtaS LetteRS

The prevalence of obesity has been steadily increasing and is a major worldwide public health problem. It is associated with multiple medical and psychological conditions and recent research supports a link to several cognitive deficit domains, including executive functioning. The aim of this article is to describe socio-demographic, clinical and neuropsychological characteristics of a sample of candidates for bariatric surgery (BS) and to compare their performance with normative values. Between May 2012 and May 2013 we evaluated the neuropsychological performance of 42 patient candidates for BS at the Morbid Obesity Consultation at Centro Hospitalar Lisboa Norte (CHLN). The population was predominantly female and education was equally distributed between basic, secondary and tertiary levels. The neuropsychological results showed a significant decrease on Recall (p < .01), Learning (p < .10), Nonverbal Memory (p < .001), Cognitive Flexibility (p < .01) and Resistance to Interference (p < .05). Despite the limitations inherent to a small sample, the results obtained in the Portuguese population coincide with those of earlier studies; namely that obesity differentially effects instrumental functions.

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) may have mood enhancement effects: higher DHEAS concentrations and DHEA/cortisol ratio have been related to lower depression scores and controlled trials of DHEA administration have reported significant antidepressant effects. The balance between DHEAS and DHEA has been suggested to influence brain functioning. We explored DHEAS, DHEA, cortisol, DHEA/cortisol and DHEAS/DHEA ratios relations to the processing of negative emotional stimuli at behavioral and brain levels by recording the electroencephalogram of 21 young women while performing a visual task with implicit neutral or negative emotional content in an audio-visual oddball paradigm. For each condition, salivary DHEA, DHEAS and cortisol were measured before performing the task and at 30 and 60min intervals. DHEA increased after task performance, independent of the implicit emotional content. With implicit negative emotion, higher DHEAS/DHEA and DHEA/cortisol ratios before task performance were related to shorter visual P300 latencies suggesting faster brain processing under a negative emotional context. In addition, higher DHEAS/DHEA ratios were related to reduced visual P300 amplitudes, indicating less processing of the negative emotional stimuli. With this study, we could show that at the electrophysiological level, higher DHEAS/DHEA and DHEA/cortisol ratios were related to shorter stimulus evaluation times suggesting less interference of the implicit negative content of the stimuli with the task. Furthermore, higher DHEAS/DHEA ratios were related to reduced processing of negative emotional stimuli which may eventually constitute a protective mechanism against negative information overload.