Abdominal Waist Circumference Research Articles

Results of PROMESA I study; efficacy and safety of a very low calorie diet application and following alimentary reeducation with the PronoKal® method in the treatment of excess of weight

The aim of this study was to evaluate the efficacy in the reduction of weight with a cetogenic very low calorie diet followed by alimentary reeducation according to the PronoKal® method in patients with overweight and obesity, and the safety during the procedure. Retrospective, observational and multicentre study where the patient's descriptive variables, variables related with the ponderal change, abdominal waist circumference, and general biochemistry were statistically analysed at the end of each treatment stages, and the adverse events referred at each visit during the treatment. From the 426 evaluable cases, 62.3% of the patients were obese. The 16.7% had hyperlipemia, the 2.3% type 2 diabetes mellitus, and the 4.8% arterial hypertension. At the end of treatment, the mean weight lost was 17.1 ± 8.0 kg (p < 0.001), with a BMI reduction of 6.2 ± 3.0 kg/m2. The 54.2% of the patients achieved the status of normoweight (35.9% of obese patients), higher in women than in men (62.5% vs 28.2%, respectively; p < 0.001). Waist perimeter was reduced in 17.3 ± 9.5 cm. There was an improvement in all laboratory variables in diabetic, hypertensive and dyslipemic patients, reaching statistical significance (p < 0.05) in glucose reduction (28.8%) in diabetics, in glucose (12.7%) and cholesterol (14.5%) reduction in hypertensive, and in glucose (11.7%), total cholesterol (14.5%), LDL cholesterol (11.3%) and triglycerides (37.9%) reduction in dyslipemics. The presence of adverse events was reported in 23.7% of patients, mainly constipation (23.9%). The PronoKal® method is an effective and safe method of excess weight approach, when it is done at completion and under a strict multidisciplinary medical control, improving different cardiovascular risk parameters.

Obesity, diabetes, and associated risk factors

The prevalence of obesity has increased in the past 10 years. Recent studies have associated obesity with other cardiovascular risk factors, and an increased risk of diabetes and cardiovascular death. Patients with obesity should undergo a global evaluation cardiovascular risk, including measurement of abdominal waist circumference, assessment of standard cardiovascular risk factors, screening for dyslipidemia, abnormal glucose metabolism, and hypertension. Recommendations for dietary modification should be tailored to the patient's associated medical conditions, such as diabetes, dyslipidemia, and hypertension, and all patients should be instructed on the importance of monitoring caloric intake. For patients who can engage in regular physical activity, we recommend a minimum regimen of 150 min/wk of moderate intensity exercise, such as brisk walking. Use of pharmacotherapy for obesity can be considered when efforts at therapeutic lifestyle modification have been ineffective, but patients must be carefully screened because many agents have potential side effects. Surgical approaches for obesity have also been demonstrated to be effective in achieving and sustaining weight loss and improving markers of cardiovascular risk and should be considered in patients who are refractory to therapeutic lifestyle modification. All diabetic patients should be treated comprehensively to reduce other comorbid conditions, including hypertension and dyslipidemia. Hypoglycemic therapy should be initiated when efforts to reduce hyperglycemia to target thresholds fail.

Management of the Metabolic Syndrome

The metabolic syndrome is most commonly defined as the presence of three or more of the following atherogenic risk factors: increased abdominal waist circumference, hypertriglyceridemia, low serum high-density lipoprotein level, raised blood pressure, and a fasting blood sugar level greater than 110 mg/dL. It is associated with increased risk for the development of atherosclerosis and cardiovascular disease. Current management recommendations promote therapeutic lifestyle changes (mainly diet and exercise) for all of the core elements of the syndrome. Pharmacologic therapy is indicated in most patients with atherogenic dyslipidemia and in some with hyperglycemia and raised blood pressure. These therapeutic measures are able to favorably modify the core components of the metabolic syndrome and it is hoped that they will also improve the long-term cardiovascular prognosis in patients with this disorder.