ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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conferenceObject LACTATE AS MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY Basic science and research in bariatric surgery(2019) VIEIRA, A. Gadducci; CARDIA, L.; OLIVEIRA, F. Costa De; MARIA, J. Greve De; SANTOS, P. Silva Roberto; PAJECKI, D.; AURELIO, M. Santo; CLEVA, R. DeconferenceObject BODY COMPOSITION AND RESTING METABOLIC RATE IN WEIGHT LOSS AFTER BARIATRIC SURGERY(2016) SANTO, M. A.; MOTA, F. C.; V, A. Gadducci; SANTAREM, G. C.; SILVA, P. R.; GREVE, J.; CLEVA, R.- Muscle strength and body composition in severe obesity(2017) GADDUCCI, Alexandre Vieira; CLEVA, Roberto de; SANTAREM, Gabriela Correia de Faria; SILVA, Paulo Roberto Santos; GREVE, Julia Maria D'Andrea; SANTO, Marco AurelioOBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m(2) (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m(2) (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.
- LACTATE CAN BE A MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY?(2021) DE-CLEVA, Roberto; CARDIA, Lilian; VIEIRA-GADDUCCI, Alexandre; GREVE, Julia Maria; SANTO, Marco AurelioBackground: In the last decades, numerous studies have confirmed the importance of lactate by-product to the nutrient signal of the intracellular redox state to regulatory functions in energy metabolism. Aim: To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile. Methods: Twenty-four people with severe obesity (BMI=40 kg/m(2)) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry. Results: The initial lactate level was 2.5 +/- 1.1 mmol/l and returned to normal level (1.9 +/- 3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein. Conclusions: There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.
- TRUNK BODY MASS INDEX: A NEW REFERENCE FOR THE ASSESSMENT OF BODY MASS DISTRIBUTION(2018) TAKESIAN, Mariane; SANTO, Marco Aurelio; GADDUCCI, Alexandre Vieira; SANTAREM, Gabriela Correia de Faria; GREVE, Julia; SILVA, Paulo Roberto; CLEVA, Roberto deBackground: Body mass index (BMI) has some limitations for nutritional diagnosis since it does not represent an accurate measure of body fat and it is unable to identify predominant fat distribution. Aim: To develop a BMI based on the ratio of trunk mass and height. Methods: Fifty-seven patients in preoperative evaluation to bariatric surgery were evaluated. The preoperative anthropometric evaluation assessed weight, height and BMI. The body composition was evaluated by bioimpedance, obtaining the trunk fat free mass and fat mass, and trunk height. Trunk BMI (tBMI) was calculated by the sum of the measurements of the trunk fat free mass (tFFM) and trunk fat mass (tFM) in kg, divided by the trunk height squared (m(2)). The calculation of the trunk fat BMI (tfBMI) was calculated by tFM, in kg, divided by the trunk height squared (m(2)). For the correction and adjustment of the tBMI and tfBMI, it was calculated the relation between trunk extension and height, multiplying by the obtained indexes. Results: The mean data was: weight 125.3 +/- 19.5 kg, height 1.63 +/- 0.1 m, BMI was 47 +/- 5 kg/m(2) and trunk height was 0.52 +/- 0,1 m, tFFM was 29.05 +/- 4,8 kg, tFM was 27.2 +/- 3.7 kg, trunk mass index was 66.6 +/- 10.3 kg/m(2), and trunk fat was 32.3 +/- 5.8 kg/m(2). In 93% of the patients there was an increase in obesity class using the tBMI. In patients with grade III obesity the tBMI reclassified to super obesity in 72% of patients and to super-super obesity in 24% of the patients. Conclusion: The trunk BMI is simple and allows a new reference for the evaluation of the body mass distribution, and therefore a new reclassification of the obesity class, evidencing the severity of obesity in a more objectively way.
- Correlation between Body Composition and Walking Capacity in Severe Obesity(2015) SANTAREM, G. Correia de Faria; CLEVA, R. de; SANTO, Marco Aurelio; BERNHARD, Biaseto; GADDUCCI, Alexandre Vieira; GREVE, Julia Maria D'Andrea; SILVA, Paulo Roberto SantosBackground Obesity is associated with mobility reduction due to mechanical factors and excessive body fat. The six-minute walk test (6MWT) has been used to assess functional capacity in severe obesity. Objective To determine the association of BMI, total and segmental body composition with distance walked (6MWD) during the six-minute walk test (6MWT) according to gender and obesity grade. Setting University of Sao Paulo Medical School, Brazil; Public Practice. Methods Functional capacity was assessed by 6MWD and body composition (%) by bioelectrical impedance analysis in 90 patients. Results The mean 6MWD was 514.9 +/- 50.3 m for both genders. The male group (M: 545.2 +/- 46.9 m) showed a 6MWD higher (p = 0.002) than the female group (F: 505.6 +/- 47.9 m). The morbid obese group (MO: 524.7 +/- 44.0 m) also showed a 6MWD higher (p = 0.014) than the super obese group (SO: 494.2 +/- 57.0 m). There was a positive relationship between 6MWD and fat free mass (FFM), FFM of upper limps (FFM_UL), trunk (FFM_TR) and lower limbs (FFM_LL). Female group presented a positive relationship between 6MWD and FFM, FFM_UL and FFM_LL and male group presented a positive relationship between 6MWD and FFM_TR. In morbid obese group there was a positive relationship between 6MWD with FFM, FFM_UL, FFM_TR and FFM_LL. The super obese group presented a positive relationship between 6MWD with FFM, FFM_TR and FFM_LL. Conclusions Total and segmental FFM is associated with a better walking capacity than BMI.
- Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss(2019) SERAFIM, Marcela Pires; SANTO, Marco Aurelio; GADDUCCI, Alexandre Vieira; SCABIM, Veruska Magalhaes; CECCONELLO, Ivan; CLEVA, Roberto deOBJECTIVE: To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS: We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS: The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS: The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.
conferenceObject RESTING METABOLIC RATE AND BODY COMPOSITION AFTER 36 MONTHS OF BARIATRIC SURGERY Basic science and research in bariatric surgery(2019) VIEIRA, A. Gadducci; CARDIA, L.; SANTOS, P. Silva Roberto; ANDREA, J. Greve Maria D.; AURELIO, M. Santo; CLEVA, R. De- Modified body adiposity index for body fat estimation in severe obesity(2017) BERNHARD, A. B.; SCABIM, V. M.; SERAFIM, M. P.; GADDUCCI, A. V.; SANTO, M. A.; CLEVA, R. deBackgroundThe body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity. MethodsA cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equationin this population. The new equationproposed was validated in another 158 patients with severe obesity (Group 2: G2). ResultsThere was a significant difference between BF determination by BIA and BAI (P=0.039). The mean (SD) BF in G1 was 52.3%(6.1%) determined by BIA and 51.6%(8.1%) determined by BAI. Sex, waist-hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation(modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI%=23.6+0.5x(BAI); add 2.2 if body mass index50kgm(-2) and 2.4 if WHR1.05]. The new equationreduced the difference [1.2% (5.9%), P<0.001 to 0.4%(4.12%), P=0.315] and improved the correlation (0.6-0.7) between methods. ConclusionsBAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.
- Resting metabolic rate and weight loss after bariatric surgery(2018) CLEVA, Roberto de; MOTA, Filippe Camarotto; GADDUCCI, Alexandre Vieira; CARDIA, Lilian; GREVE, Julia Maria D'Andrea; SANTO, Marco AurelioBackground: There is an increased interest in understanding how variation in body composition (BC) and energy expenditure is related to successful weight loss after surgery. It has been suggested that low resting metabolic rate (RMR) could be associated with poor weight loss. Objectives: To determine the relation among changes in BC, RMR, and weight loss after bariatric surgery. Setting: University tertiary care hospital, Brazil. Methods: A cohort of 45 patients submitted to bariatric surgery was prospectively studied. BC was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before and 6 months after surgery. The RMR value was adjusted per kilogram of weight (RMR/kg). The patients were divided in 4 groups, based on patterns of change in the RMR/kg after surgery. The RMR/kg could decrease (group 1), remain stable (group 2), have a small increase (group 3), or have a major increase (group 4). Results: A significant relation between fat-free mass and RMR for both pre- (P <.01) and postoperative periods (P <.01) was observed. Excess weight loss had a significantly correlation only with post-RMR/kg (P <.01). The pattern of change in RMR/kg was strongly correlated with weight loss, considering an excess weight loss >50% a successful weight loss: No patients achieved success in group 1; 61% of patients did in group 2; 80% di in group 3; and all patients in group 4 had successful weight loss. Conclusions: We demonstrate a clearly correlation between the postoperative RMR and weight loss. The increase in RMR/kg after surgery is a major factor related to a satisfactory excess weight loss after surgery.