La problématique de la surcharge pondérale est pandémique. Un nombre important d’études épidémiologiques robustes mettent en évidence un gradient socio-économique (SSE) en lien avec cette problématique: le risque de surpoids ou d'obésité diminuerait graduellement avec l’accroissement du SSE. Toutefois, les données canadiennes récentes montrent que ce gradient est inversé pour les hommes au Canada. Nos objectifs sont (1) de vérifier si ce phénomène de gradient SSE inversé s’applique autant à l’embonpoint, qu’à l’obésité; (2) nous présenterons et discuterons trois grandes hypothèses susceptibles d'expliquer les inégalités sociales de surcharges pondérales (sociodémographique, habitudes de vie et psychosociale). Méthodologie : nous réalisons nos analyses à partir d’un échantillon de personnes âgées de 25 à 65 ans ayant répondu aux questions de l’Enquête sur la santé dans les collectivités canadiennes cycle 2.2 volet-nutrition (ESCC 2.2). Nous choisissons d’utiliser les données de cette enquête principalement pour ses mesures anthropométriques. Nous utilisons deux indicateurs SSE : le revenu et l’éducation. Nous utilisons des régressions logistiques simples et multinomiales. Nos résultats montrent des gradients SSE inversés entre hommes et femmes pour les liens entre le revenu et l’obésité, mais non pour l’embonpoint. Nous observons des gradients SSE avec l’éducation, mais principalement pour les femmes et l’obésité. Que pour les hommes aucune des hypothèses explicatives n’aura su atténuer l’effet du revenu, tant pour l’embonpoint que pour l’obésité. Chez les femmes l’effet de l’éducation et des habitudes de vie expliquent majoritairement l’effet du revenu sur l’obésité. Conclusion : nous montrons par nos résultats qu’en se concentrant uniquement que sur les aspects individuels de la surcharge pondérale, nous limitons notre compréhension des inégalités sociales en matière de surcharge pondérale, particulièrement celles entre le genre. / Overweight and obesity are an epidemic health problem Worldwide. A large number of Epidemiological studies demonstrate social gradient (SES) whit this problematic: the higher the socioeconomic level of the household the lower the Overweight or Obesity rate are. Recent Canadian data shows that the likelihood of being overweight follows a socio economic (SES) gradient. However, the risk increases with the SES for men and decreases for women. Our aims are (1) to examine if this gender-reversed SES gradient is observable for pre-obesity as well as for obesity; and (2) to which extent this gradient can be explained by, socio-demographic, psychosocial and behavioural factors. Methods: Data was derived from a subsample of Canadian adults (25-65 years) who responded to the Canadian Community Health Survey (CCHS 2.2, Statistics Canada). We choose this survey because the BMI is derived from anthropometric measures of weight and height. We used two SES indicators: education level and measure of income sufficiency calculated by Statistics Canada. Multinomial logistic regressions were used to test our hypotheses’. Our results show a gender-reversed gradient for obesity but not for pre-obesity. Pre-obesity is significantly and positively associated to SES for men, but no significant relationship was found for women. For men, socio-demographic, behavioural and psychosocial factors neither contribute in explaining the relationship between SES and pre-obesity or obesity. For women, behavioural factors, mainly physical activity, contribute, however marginally, to reducing the gap between the poorest and the richest. In conclusion, these results show that targeting individual factors is a limited approach towards reducing overweight social inequalities.

In the general population, one in five couples experiences difficulty in conceiving a child. The role of obesity on women’s fecundity has become a focus of attention in recent years. Successful treatment of infertility through Assisted Reproductive Technology (ART) is also compromised by the presence of obesity, which occurs in 30 % of women seeking treatment. A negative correlation exists between increased body mass index (BMI) and the number of collected oocytes and a lower birth rate after ART. Furthermore, a number of studies have established that weight loss improves natural conception rates in overweight women. Whether weight management can improve success rates in overweight / obese women undergoing in vitro fertilisation (IVF) has not been studied. The purpose of this project was to explore the role of short–term weight loss on potential pregnancy outcomes in overweight / obese women undergoing IVF programme. However, to establish this relationship, we proposed to carry out two studies to assess the following: (I) The feasibility of very low calorie diet (VLCD) during IVF treatment with respect to duration, level of restriction and tolerability of the diet during hormonal down regulation in women (Chapter 2). (II) How energy restriction may affect the quality of an early embryo in diet - induced obese mice with respect to various body weight and caloric intake (Chapter 3). In study (I), women preferred a shorter dietary intervention with greater energy restriction (456 kcal per day) to gradual energy restriction (1200 kcal / day for the first week, and afterward, 456 kcal / day) prior to oocyte transfer. Women were able to comply with the VLCD during IVF treatment and both dietary groups achieved a significant weight loss (mean 6.3 %). In study (II), by using obese mice, the effect of rapid weight loss (mean 12 %) was observed after 5 days of energy restriction. Ovulation rate was greater in the Obese group (HFD) (55.6%) and equal in both Control (CD) and Energy Restricted (HF / ER) (44.4 %) groups. The HF / ER group showed higher fertilisation rate (80 %) than HFD and CD (55% and 45.5%, correspondingly). The blastocyst stage was reached by half of the cultured embryos in both HF / ER and HFD groups and 33 % in the CD group. The quality of embryos that completed blastocyst formation did not differ between groups. However, postfertilisation development in females fed a high fat diet was slower compared to CD and HF / ER groups. In conclusion, this work illustrated a weight management prior conception and use of VLCD during IVF treatment in clinical study needs further investigation with regard to the dietary duration, level of energy restriction and how this combination will influence IVF treatment outcomes. Furthermore, as we were unable to determine the question of how the dietary intervention affects the quality of oocytes and the animal study illustrated a promising result, thus further studies are required. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1311579 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 2008

Made available in DSpace on 2015-07-22T20:50:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-27 / Introdução/Objetivo: Os fatores orexígenos e anorexígenos e a Taxa Metabólica de Repouso (TMR) desenvolvem um importante papel no controle e regulação do balanço energético e estão diretamente relacionados com a obesidade. Com base nesta relação, o objetivo desta pesquisa foi verificar os efeitos do tratamento multidisciplinar de longo prazo nos fatores orexígenos e anorexígenos e na TMR em adolescentes obesos. Metodologia: No presente estudo foram selecionados 20 adolescentes obesos (11 meninas e 9 meninos), com idade entre 14 e 19 anos. Os critérios de inclusão foram o IMC percentil > 95 de acordo com o Centers for Disease Control and Prevention e estágio de maturação sexual pós púbere. Os fatores orexígenos e anorexígenos foram avaliados por radioimunoensaio. A TMR foi mensurada por calorimetria indireta, a composição corporal por Pletismografia e a gordura visceral e subcutânea por Ultra-sonografia. Resultados: Após 12 meses de intervenção, os adolescentes obesos apresentaram diminuição significativa na massa corporal total, no IMC, na gordura corporal (% e em kg,), na massa magra (kg), e na gordura visceral e subcutânea. O grupo não apresentou diminuição significativa da TMR. Os fatores anorexígenos diminuíram significativamente e o MCH aumentou ao término da terapia. Conclusão: Podemos concluir que a terapia multidisciplinar de longo prazo foi efetiva para melhorar a composição corporal, os fatores orexígenos e anorexígenos, contribuindo para o controle da obesidade e do balanço energético. Palavras-Chave: Fatores orexígenos e anorexígenos; taxa metabólica de repouso; adolescente obeso; terapia multidisciplinar. / Background/Aims: anorexigenic and orexigenic factors and resting metabolic rate (RMR) play an important role in the energy balance and they are directly related to obesity. In this way, it was verified the effects of long-term multidisciplinary therapy on orexigenic and anorexigenic factors and resting metabolic rate in obese adolescents. Methods: Twenty obese adolescents (11 girls and 9 boys) aged between 14 and 19 years, BMI > 95th percentile of CDC, were submitted to intensive long-term multidisciplinary therapy during 12 months. Orexigenic and anorexigenic factors concentrations were measured by a radioimmunoassay (RIA) kit. RMR was measured by indirect calorimetry. Body composition was measured by pletismography, and visceral and subcutaneous fat were analyzed by ultrassonography. Results: After one year of multidisciplinary therapy, the obese adolescents presented a significant decrease in body mass (p<0.001), BMI (p<0.001), fat mass (kg and %), lean mass (kg), subcutaneous and visceral fat. The group did not decrease significantly in RMR and RMR/FFM. The anorexigenic factors (leptin and alpha- MSH concentrations) decreased significantly. The orexigenic neuropeptide (MCH) increased by the end of the multidisciplinary therapy. Conclusion: Our investigation demonstrated that long-term multidisciplinary therapy was effective to improve body composition, anorexigenic and orexigenic factors contributing to obesity control. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Luciana Sebin (lusebin@ufscar.br) on 2016-09-30T13:22:56Z No. of bitstreams: 1 TeseTNRS.pdf: 3393157 bytes, checksum: 682438684830bd99a65a205955a0aa2f (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-13T20:41:02Z (GMT) No. of bitstreams: 1 TeseTNRS.pdf: 3393157 bytes, checksum: 682438684830bd99a65a205955a0aa2f (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-13T20:41:12Z (GMT) No. of bitstreams: 1 TeseTNRS.pdf: 3393157 bytes, checksum: 682438684830bd99a65a205955a0aa2f (MD5) / Made available in DSpace on 2016-10-13T20:41:23Z (GMT). No. of bitstreams: 1 TeseTNRS.pdf: 3393157 bytes, checksum: 682438684830bd99a65a205955a0aa2f (MD5) Previous issue date: 2016-02-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Global phenomena such as population aging, increased rate of disability, and growing numbers of obese people have gained intense attention within the air transportation industry since it expects increases in travel and changes in the profile of users. However, studies have indicated gaps between the needs of passengers and the services and assistance provided by airlines and airports. Therefore, the objective of this study was to understand the contradictions and discontinuities in the activity systems of passengers with disability, elderly and obese in the Brazilian air transportation originating restrictions to participation during the flight and during the boarding and deplaning process of air travel. In the present study, a qualitative approach was adopted based on Ergonomics and the Activity Theory. The research participants were passengers with physical, visual, and auditory disabilities and elderly and obese passengers. A combination of methods and techniques was used for data collection, including: 14 preliminary interviews in health care organizations and facilities that provide assistance and services for the participant groups and air transportation users, with a total of 25 participants; a questionnaire survey involving 399 respondents; and observations in commercial aviation. A total of 43 non-participant observations were carried out, and other eight participant observations took place during the journey, which included two self-confrontation interviews. The results indicated passenger participation restrictions during the journey affect attitudinal barriers and limited spatial accessibility that are related to airport infrastructure, airport signs, operational factors, equipment, aircrafts, and regulatory aspects. These restrictions are related to contradictions in the interaction of the components of activity system, which include: the passenger, the artifacts, the rules, the community (passengers and workers), the airport operators, and the airlines, and the object of the activity. It was found that, in order to face these difficulties, passengers employ personal and interpersonal strategies. Therefore, specifications were developed to change the contextual factors associated with the environment, equipment, and operations. To promote full participation during the air journey, some changes are needed; primarily transformation in significance and representations for action of people involved in the air transportation and their work activity, seeking to achieve integration between design and use. This study was carried out focusing on the activity, which contributed to the involvement of different social actors; thus the information provided is based on the learning gained from experience and interaction with the subjects and the context aiming to demonstrate the users’ needs and constraints and support new air transport developments. / Fenômenos populacionais mundiais, como o envelhecimento, o aumento do número de pessoas com deficiência e de pessoas obesas, estão ganhando relevância na indústria de transporte aéreo, uma vez que se espera o aumento das viagens e modificações no perfil de usuários deste modal. No entanto, pesquisas indicam lacunas entre as necessidades dos passageiros e os serviços e condições oferecidas pelas companhias aéreas e aeroportos. Nesse sentido, o objetivo deste estudo foi compreender as contradições e descontinuidades nos sistemas de atividades dos passageiros com deficiência, idosos e obesos no transporte aéreo brasileiro que originam restrições a participação durante o voo e as fases de embarque e desembarque nas viagens aéreas. O desenvolvimento da pesquisa adotou um enfoque qualitativo, seguindo como fundamentação teórico-metodológica a Ergonomia da Atividade e a Teoria da Atividade. Os participantes do estudo foram passageiros com deficiência (física, visual e auditiva), passageiros idosos e passageiros obesos. Uma articulação de métodos e técnicas foi utilizada para a coleta de dados, que se constituiu a partir de 14 entrevistas preliminares com instituições que atuam junto aos grupos em estudo e usuários do transporte aéreo, contando com 25 participantes; pesquisa com questionário envolvendo 399 respondentes e; observações na aviação comercial, sendo 43 pelo pesquisador como observador-total e oito por meio do acompanhamento de viagens, as quais possibilitaram a realização de duas entrevistas de autoconfrontação. Os resultados evidenciaram restrições à participação dos passageiros nas viagens aéreas, as quais afetam a acessibilidade atitudinal e espacial posto que se relacionam à infraestrutura dos aeroportos e sinalização, fatores operacionais, equipamentos, aeronaves e aos aspectos regulatórios. Estas restrições originam-se nas contradições existentes na interação entre os componentes dos sistemas de atividade, que incluem o passageiro, os artefatos, as regras, a comunidade (atendentes e passageiros), os operadores aeroportuários, as companhias aéreas e o objeto da atividade. Para enfrentamento das dificuldades, constatou-se que os passageiros dispõem de estratégias, classificadas, principalmente, como pessoais e interpessoais. Deste modo, foram sistematizadas especificações para melhoria dos fatores contextuais, associados ao ambiente, equipamentos e operação. Para promover a plena participação nas viagens são necessárias mudanças, as quais devem iniciar-se na transformação dos significados e das representações para a ação dos envolvidos com o transporte e na atividade de trabalho destes, buscando integração entre concepção e uso. A fundamentação do estudo na perspectiva da atividade contribuiu para o envolvimento de diferentes atores sociais, de modo que as informações construídas estão baseadas na aprendizagem a partir da experiência e da interação com os sujeitos e o contexto para explicitar as necessidades e as restrições enfrentadas pelos usuários e fundamentar novos desenvolvimentos no transporte aéreo.

Made available in DSpace on 2014-12-17T15:37:05Z (GMT). No. of bitstreams: 1 PauloJFC_DISSERT.pdf: 1001139 bytes, checksum: 32624b3dc04255ae3e75e4e16600e75d (MD5) Previous issue date: 2011-08-08 / A disfun??o sexual corresponde a altera??es em uma ou mais fases da resposta sexual humana e apresenta maior preval?ncia na popula??o feminina. Ademais, a participa??o de alguns fatores como obesidade e n?veis dos horm?nios esteroidais na disfun??o sexual feminina (DSF) permanece incerta. O presente estudo deteve-se na an?lise da ocorr?ncia de DSF numa popula??o de mulheres portadoras de obesidade, cadastradas no Ambulat?rio de Cirurgia Bari?trica do Hospital Universit?rio Onofre Lopes, da Universidade Federal do Rio Grande do Norte, no munic?pio de Natal, RN. O estudo foi realizado em uma amostra composta por trinta e uma mulheres, com idade entre 20 e 50 anos, com ?ndice de massa corp?rea (IMC) > 30 Kg/m2. A todas as pacientes foi aplicado um question?rio composto por uma se??o com dados socio-econ?micos, e outra abordando a sa?de sexual feminina, sendo esta ?ltima correspondente ao Female Sexual Function Index (FSFI), para diagn?stico de DSF. A partir dessa caracteriza??o, as pacientes foram reunidas nos grupos CD (pacientes com disfun??o, n= 9) e SD (sem disfun??o, n= 22). Para a an?lise do efeito da obesidade na DSF, as pacientes foram reunidas nos grupos 1 (6 pacientes com IMC grau I e II: entre 30 e 40 Kg/m2) e 2 (25 com IMC grau III: acima de 40). Para o estudo da participa??o dos horm?nios esteroidais foram determinadas as concentra??es s?ricas de cortisol, estradiol e dehidroepiandrosterona (DHEA) pelo m?todo de quimiluminesc?ncia. A an?lise estat?stica dos dados foi realizada usando os testes ANOVA, MANOVA (Pillai), al?m de an?lise de Cluster. Para identificar as diferen?as entre os dom?nios do FSFI, foi usado o teste T de Student. A signific?ncia considerada para todos os testes foi para p< 0,01. Das pacientes estudadas, 25,8% apresentaram DSF de acordo com o escore total do FSFI. A an?lise estat?stica posterior evidenciou que as diferen?as ocorreram para os dom?nios desejo, excita??o e orgasmo. N?o foi encontrada rela??o da presen?a de DSF com os diferentes graus de obesidade ou com os n?veis hormonais dos ester?ides cortisol, estradiol ou DHEA. Contudo, foi encontrado aumento significativo nos n?veis s?ricos de estradiol para o grupo 1, que corresponde ao de menor ?ndice de IMC. Estes resultados mostram que a preval?ncia de DSF n?o diferiu entre os graus I,II e III de obesidade das pacientes deste estudo mas, quando presente, a disfun??o ocorre nos dom?nios desejo, excita??o e orgasmo. A maior concentra??o de estradiol encontrada nas pacientes de menor ?ndice de IMC sugere uma poss?vel rela??o entre as duas vari?veis que precisa ser investigada em estudos futuros. / Sexual dysfunction corresponds to changes in one or more phases of human sexual response and it has major prevalence in women. At the same time, the participation of some factors such as obesity and levels of steroid hormones in female sexual dysfunction (FSD) remains uncertain. This study analyzed the occurrence of DSF in a population of obese women part of the Bariatric surgery clinic at the Onofre Lopes Academic Hospital of the Federal University of Rio Grande do Norte, Natal, RN. The study was conducted in a sample of thirty-one women, aged between 20 and 50 years with body mass index (BMI) > 30 kg/m2. All patients answered a questionnaire consisting of two sections addressing socioeconomic conditions and female sexual health, the latter corresponding to the Female Sexual Function Index (FSFI) for the diagnosis of FSD. Using this characterization the patients were divided in groups CD (nine patients with dysfunction) and SD (twenty-two patients with no sexual dysfunction). To analyze the effect of obesity on the DSF, the patients were divided in groups 1 (6 patients with obesity grade I and II: BMI between 30 and 40 kg/m2) and 2 (22 patients with obesity grade III: BMI above 40). To investigate the role of steroid hormones, serum levels were determined for cortisol, estradiol, and dehydroepiandrosterone (DHEA), using chemiluminescence method. The statistical analysis was performed using ANOVA, MANOVA (Pillai) and cluster analysis. To identify the differences between the domains of the FSFI, was used the Student t test. The significance level for all tests was p <0.01. Of the patients studied, 25.8% had DSF according to the total FSFI score. The statistical analysis showed that the differences occurred for the domains desire, arousal and orgasm. No relationship was found for the presence of DSF with different degrees of obesity and steroid hormone levels. However, was found significant increase in estradiol serum levels for group 1, which corresponds to the lowest BMI. These results show that the presence of FSD did not differ between grades I, II and III of obesity in this study, but, when present, dysfunction occurs in the domains desire, arousal and orgasm. The highest estradiol concentration found in patients with the lowest BMI suggests a possible relationship between the two variables, and should be investigated in future studies.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2016-11-28T16:26:19Z No. of bitstreams: 2 Tese - Camila Kellen de Souza Cardoso - 2016.pdf: 3418310 bytes, checksum: cdf808292a924eda861aac5082af3dde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-11-28T17:23:33Z (GMT) No. of bitstreams: 2 Tese - Camila Kellen de Souza Cardoso - 2016.pdf: 3418310 bytes, checksum: cdf808292a924eda861aac5082af3dde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-11-28T17:23:33Z (GMT). No. of bitstreams: 2 Tese - Camila Kellen de Souza Cardoso - 2016.pdf: 3418310 bytes, checksum: cdf808292a924eda861aac5082af3dde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-11-11 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Aim: To assess the associated factors to bone mineral density (BMD), as well as the effects of extra virgin olive oil and the Brazilian Traditional Diet (DietBra) on bone health of severely obese patients. Methods: The first study refers to baseline data of a randomized clinical trial (RCT) that analyzes sociodemographic factors, lifestyle, health conditions, anthropometric and biochemical data associated with BMD of total body, total vertebral column, and total hip. The second study is a blind RCT with three groups of intervention: olive oil, receiving 52 ml/day of extra virgin olive oil and habitual dietary intake; diet, receiving a DietBra; and olive oil + DietBra, receiving 52 ml/day of olive oil and healthy diet prescription. The three groups had monthly consults with a nutritionist and were followed-up during 12 weeks. BMD of total vertebral column was primary outcome of the RCT, while BMD of otal hip, calcium, vitamin D, and parathormone (PTH) were secondary outcomes. Data collection occurred between June 2015 and February 2016 with 111 severely obese patients (Body Mass Index ≥ 35 kg/m2 ). The allocation ratio between groups in the RCT was 1:1:1. BMD was evaluated by Dualenergy x-ray absorptiometry. Kolmogorov-Smirnov test was employed to verify normal distribution of continuous data. Student’s t-test, ANOVA, Bonferroni, simple linear regression, and hierarchic multiple linear regression were used to analyze baseline data. Fisher’s exact test, Pearson’s chi-square test, unpaired Student’s t-test, ANOVA, Bonferroni, and ANCOVA were used to analyze the data from the clinical trial by intention to treat. The significance level was set at p<0.05. Results: At the first level of baseline, men presented higher BMD of total body than women (p≤0.001), while advanced age was associated with lower BMD in the three measurement sites (p=0.047, 0.039 and 0.010). At the second level, having diabetes mellitus type 2 (DM2) was associated with higher BMD of total body (p=0.033), while ≥150 min/week of aerobic physical activity was associated with higher BMD of vertebral column (p=0.028) and total hip (p=0.004). Patients presenting previous fracture (p=0.013) and with a higher degree of obesity (p=0.015) had lower BMD of total vertebral column. Having an adequate intake of vitamin D was associated with higher BMD of total vertebral column (p=0.020). At the third level, low serum zinc (p=0.024) and elevated C-reactive protein (p=0.049) were associated with lower BMD of total vertebral column. In the RCT, the olive oil group presented an increase in serum calcium between baseline and the end of follow-up (p=0.007). Mean serum calcium was higher in the olive oil group compared to the olive oil + DietBra group at the end of follow-up (p=0.026). The DietBra group presented a higher means BMD of total vertebral column (p=0.016) and BMD of total hip (p=0,029) than the olive oil + DietBra group. In addiction, the PTH reduced in DietBra group after intervention (p=0.047) and delta PTH was higher in the DietBra group compared to the olive oil + DietBra group (p=0.042). Conclusion: Classic factors associated with bone health as gender, advanced age, physical activity, previous fracture, vitamin D intake and C-reactive protein also occurred in severely obese individuals, although tobacco use, solar exposure, medication use, serum calcium and vitamin D were not associated with BMD. Furthermore, the DietBra increased BMD of total vertebral column and reduced PTH, while the extra virgin olive oil was increased serum calcium. In a separate way, both interventions had good results for severely obese patients' bone health. / Objetivo: Avaliar os fatores associados a densidade mineral óssea (DMO), assim como os efeitos do azeite de oliva extravirgem e dieta tradicional brasileira (DietBra) na saúde óssea de obesos graves. Metodologia: o primeiro estudo trata-se de dados do baseline do ensaio clínico randomizado (ECR), com análise de fatores sociodemográficos, estilo de vida, condições de saúde, dados antropométricos e bioquímicos associados à DMO de corpo total, coluna total e quadril total. O segundo estudo é um ECR cego, com três grupos de intervenção: grupo azeite que recebeu 52 mL/dia (4 sachês) de azeite de oliva extravirgem e manteve a alimentação habitual, o grupo DietBra que recebeu prescrição de dieta saudável com padrão de dieta tradicional brasileira e o grupo azeite + DietBra que recebeu 52 mL/dia (4 sachês) e prescrição de dieta saudável com padrão de dieta tradicional brasileira. Os três grupos tiveram consultas mensais, em dias diferentes da semana, com seguimento de 12 semanas, foram avaliadas a DMO de coluna total como desfecho primário e DMO de quadril total, cálcio, vitamina D e paratormônio (PTH) como desfechos secundários do ECR. A coleta de dados ocorreu entre junho de 2015 e fevereiro 2016, com 111 pacientes obesos graves (índice de massa corporal ≥35 kg/m2 ), com proporção entre os grupos do ECR em torno de 1:1:1. A DMO foi avaliada pelo método de Dual-energy X-ray absorptiometry (DXA). Foi empregado o teste Kolmogorov-Smirnov para verificar a normalidade dos dados. Para os dados do baseline foi utilizado T de Student ou Anova, seguindo de Bonferroni, Regressão Linear Simples e Regressão Linear Múltipla modelo hierarquizado. Para o ECR foi utilizado Teste Exato de Fisher ou QuiQuadrado de Person, T de Student, ANOVA seguida de Bonferroni e ANCOVA, foi adotada a abordagem estatística por intenção de tratar por meio da aplicação do teste T Student não-pareado intra grupo. Foi considerado p<0,05. Resultados: no primeiro nível do baseline, homens apresentaram maior DMO de corpo total (p= <0,001) do que mulheres, enquanto a idade avançada foi associada a menor DMO nos três sítios (p=0,047, 0,039 e 0,010). No segundo nível, ter diabetes mellitus tipo 2 (DM2) foi associado a maior DMO de corpo total (p=0,033), enquanto ≥150 minutos/semana de atividade física aeróbica foi associada com maior DMO de coluna total (p=0,028) e quadril total (p=0,004), assim como indivíduos com fratura prévia (p=0,013) e maior grau de obesidade (p=0,015) apresentaram menor DMO de coluna total. Por outro lado, ter ingestão adequada de vitamina D esteve associado a maior DMO de coluna total (p=0,020). No terceiro nível, o zinco sérico baixo (p=0,024) e PCR elevada (p=0,049) associaram-se a menor DMO de coluna total. No ECR, o grupo azeite apresentou aumento no cálcio sérico entre o início e final do estudo (p=0,007), assim como a média final de cálcio foi maior no grupo azeite em comparação ao grupo azeite + DietBra (p=0,026), o grupo DietBra apresentou média final de DMO de coluna total (p=0,016) e DMO de quadril (p=0,029) maior do que o grupo azeite + DietBra, além disso o PTH reduziu no grupo DietBra pós a intervenção (p=0,047) e o delta PTH foi maior no grupo DietBra em comparação ao grupo azeite + DietBra (p=0,042). Conclusão: fatores clássicos associados à saúde óssea como sexo, idade mais avançada, atividade física, fratura prévia, ingestão de vitamina D e proteína C-reativa também ocorreram em obesos graves, mas tabagismo, exposição solar, uso de medicamentos, cálcio e vitamina D séricos não foram associados à DMO em obesos graves. Além disso, a DietBra aumentou DMO de coluna total e reduziu PTH, enquanto o azeite de oliva extravirgem aumentou cálcio sérico. Ou seja, de forma isolada as intervenções tiveram bons resultados para saúde óssea de obesos graves

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