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- Comparison of Body Mass Index (BMI), before and post COVID-19, across different age groups in the population of Northeast PortugalPublication . Bragada, José A.; Teixeira, José Eduardo; Bragada, João P.; Ferreira, Ana Sofia de Jesus; Magalhães, PedroOver the last few decades, there has been a significant increase in obesity levels, particularly developed countries. This rise primarily reflects changes in dietary patterns, the rise of sedentary lifestyles, and socioeconomic factors. The Body Mass Index (BMI) has been a widely used parameter with the intention of evaluating body fat at any age (1,2). Although it's not the most rigorous method (3), it has the advantage of being easy to calculate and having many records available. In Portugal, there has also been an increase in the prevalence of obesity and overweight in recent years (4). The pandemic period (COVID-19), which lasted approximately 2 years (2020 and 2021), led to lifestyle changes for many people, often resulting in a notable decrease in physical activity. How has this period affected the BMI of these specific population?
- A structural equation approach for modeling metabolic syndrome status in an adult and older North-Eastern Portuguese populationPublication . Teixeira, José Eduardo; Bragada, José A.; Bragada, João P.; Magalhães, PedroThe metabolic syndrome (MetS) is characterized by an interrelated cardiometabolic risk factors, specifically central obesity, dysglycemia, dyslipidemia and arterial hypertension. The aim of this study was to analyze the weighting factors for modeling metabolic syndrome status (3-, 4-, and 5-MetS components) in an adult and older North-Eastern Portuguese population. A cross-sectional, observational and retrospective analysis was conducted between January 2019 and December 2020 from patients’ clinical records of 3,581 individuals with MetS condition (18–102 years). A structural equation modelling (SEM) analysis was applied using a standardized root mean square residuals (SRMR) with a path-flow method and a two-step maximum likelihood approach. MetS was diagnosed using Joint Interim Statement (JIS) criteria. Confirmatory model had a good adjustement (SRMR = 0.0334), reporting the following links for weighting factors in MetS status for overall population: waist circumference (WC) (β = 0.24, 95% CI: 0.19–0.29, p <0.001), fasting glucose (FG) (β = 0.17, 95% CI: 0.12– 0.22; p <0.001), systolic blood pressure (SBP) (β = 0.14, 95% CI: 0.09–0.19; p <0.001), dyastolic blood pressure (DBP) (β = 0.06, 95% CI: 0.01–0.11; p <0.001), high-density lipoprotein cholesterol (HDL-c) (β = 0.18, 95% CI: 0.12–0.23; p ≥0.05), and triglycerides (TG) (β = 0.05, 95% CI: 0–0.10; p ≥0.05). Weighting factors with the greatest effect were WC, FG, SBP and DBP, whereas there were no significant effects for HDL and TG. The action of low-density lipoproteins and triglyceride-rich lipoproteins cannot be discarded in the accumulation of atheroma plaques, as well as in the relationship amongst atherosclerosis and major adverse cardiovascular events (MACE). Therefore, the JIS definition has been widely debated to adding a better screening criterion for modelling the MetS diagnosis and progression using other criteria such as waist-to-height ratio (WhtR), waist-to-hip ratio (WHR), mean arterial pressure (MAP) and low-density lipoproteins (LDL) levels. Also, futures multivariate models should include exercise-related variables, i.e., frequency, intensity, time and type (FITT) principles, to measure the impact of the physical exercise on the MetS status change.
- Physical activity, strength training and nutritional support in patients with metabolic syndrome from a Northeaster Portuguese primary health care: a pilot community intervention programPublication . Bragada, José A.; Teixeira, J.A.; Bragada, João P.; Duarte, Carlos Manuel Teixeira; Pontes, João H.; Saldanha, Laissa de Sousa; Magalhães, PedroThe prevalence of Metabolic Syndrome (MetS) has been increasing exponentially in the Portuguese population. Primary prevention using physical activity (PA), exercise and healthy lifestyles seems to be limited. Thus, current study aims to present the design and preliminary findings of a pilot community intervention for patients with MetS. Methods: A randomized controlled trial was conducted between April and July 2022 with patients with MetS, from a Northeaster Portuguese primary health care. Eight participants completed the three-month intervention program, 6 women (51.0±6.4 years) and 2 men (46.5±4.9 years). The program included: (1) evaluation and prescription of PA (steps/day and floors/day); (2) nutritional and dietary support; (3) strength training sessions; (3) blood testing; (4) anthropometric and body composition assessment. A pre- and post-intervention follow up was conducted. Garmin®F 745 were used for PA prescription and assessment. PA targets per day were: number of steps ≥10 000; uphill walking ≥10 floors; and minutes of intensity ≥150 per week. Nutritional and dietary evaluation was recorded by completing the food frequency questionnaire with subsequent recommendation of changes to healthy diet. The designed strength training program was: (i) frequency of 2x/week; (ii) 8 to 10 exercises, in order to work the main muscle groups; (iii) 2 sets of 10 to 12 repetitions; (iv) 60 to 70% of one maximum repetition. Blood samples evaluated glycated hemoglobin (HbA1c), fating glucose (FG), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Body weight (kg), lean body mass (kg) and fat mass percentage (%) was evaluated by bio-impedance scale (Tanita MC 780-P MA®). MetS parameters was defined by joint interim statement (JIS) criteria (Alberti et al, 2009). Results: Regarding PA parameters at the end of the three-month program, the average number of daily steps was 11 818, the number of daily floors was 15.35 and moderate to vigorous PA was 253 minutes/week. An improvement in pre- and post-intervention blood concentrations and pressure was observed, namely in HbA1c (-7.4%±15.2), FG (-4.9%±14.4), HDL (-4.8%±9.7), TC (-1.9%±19.9), SBP (-15.6%±10.7) and DBP (-12.7%±9.3). All participants registered a weight loss (-3.4%±2.0), with an increase in lean mass (-4.5%±2.0) and a decrease in fat mass (-8.7%±6.3). Except for one participant, all improved in heart rate recovery after exercise (19.3%±28.2), suggesting an improvement in cardiovascular capacity. Conclusions: The effect of the implemented pilot community intervention program was greater in the participants who followed the program more rigorously. Additionally, the strength training may have been important in increasing lean body mass. The inclusion of PA, strength training and nutritional support in primary health care, through a supervised program, seems to be a key strategy to reduce the risk associated with MetS and delay the complications associated with cardiometabolic diseases.
- Evaluating and prescribing physical activity and exercise in health centers for individuals with metabolic syndrome: moving from pilot study to broad implementationPublication . Teixeira, José Eduardo; Bragada, José A.; Bragada, João P.; Reis, Luís; Magalhães, PedroPhysical activity (PA) and exercise are vital for health promotion (Ács et al., 2020; Blue, 2017). Regular exercise, combined with dietary advice, significantly improved to normal values the metabolic syndrome (MetS) factors (Magalhães et al., 2023; Teixeira et al., 2022). Thus, the health centres should provide PA assessment and prescription, ensuring trained personnel, dedicated space, and regular follow-up for patients (Bragada et al., 2023). Indeed, the exponential increase of MetS conditions such as obesity, dysglycemia, dyslipidemia and hypertension, will impose an medical expenses on healthcare systems with indirect costs in labour productivity and missed work days (Hone et al., 2019; WHO, 2021). This global problem can only be solved with health education and exercise-based primary prevention (Hone et al., 2019). In our pilot study conducted over a 3-month period in collaboration with family physicians, focusing on individuals with MetS, we found that regular PA and exercise, combined with dietary counselling, had a significant impact on improving MetS risk factors, particularly fasting blood glucose, diastolic blood pressure, and systolic blood pressure. Anthropometric variables showed improvements in weight, lean body mass, and body fat mass. In regard to glycated hemoglobin (HbA1c), there was a clinically significant reduction in the majority of participants. Additionally, exercise led to an improvement in heart rate recovery after exercise, reflecting an increase in cardiovascular capacity (Bragada et al., 2023). In this context, it would be highly beneficial if health centres had the necessary resources and qualified personnel to assess and prescribe physical exercise for specific population groups who, based on medical advice, should increase their engagement in exercise and physical activities (Magalhães et al., 2023; Teixeira et al., 2022). The intervention strategies of health centres can take into account the following aspects: (1) set up multidisciplinary task force with a qualified physical exercise professional or exercise physiologist, a nutritionist and a nurse; (2) providing a suitable and dedicated space for conducting physical activity and dietary counselling consultations; (3) acquiring essential basic equipment for assessments; (4) having the family physician refer the patient to the PA consultation during their visit; (5) conducting regular assessments of physical activity levels and clinical analyses; (6) implementing longitudinal follow-up.