Abstract Aim: This study aims to compare the sleep parameters in Paralympic powerlifting athletes during days with and without training, and to analyze the relationship between the training load and sleep on the same day and the relationship between the previous night's sleep and the training load of the following day. Methods: Actigraphy was used to analyze the sleep parameters of 11 Paralympic powerlifting athletes for 14 days (7 days without and with training), whereas Ratings of Perceived Exertion (RPE) analysis was used to assess training load. In addition, the Horne and östberg chronotype questionnaire and the Epworth Sleepiness Scale were applied. Results: Athletes show morning and indifferent chronotype and low daytime sleepiness. We found that on training days, sleep onset latency (SOL) was lower (average 5.3 min faster), whereas total sleep time (TST) and sleep efficiency (SE) were higher (TST averaged 169 min and SE 7% higher) compared to non-training days. In addition, the TST of the night before the training days correlated positively with the RPE of the following day, and the training volume correlated negatively with the SE of the same day. Conclusion: Our findings show that Paralympic powerlifting training had positive effects in increasing TST and SE and decreasing SOL on training days. These results show the positive effects of this type of training in improving sleep in athletes with physical disabilities. In addition, a good night's sleep the day before training can make it possible to put more effort into the next day's training. Therefore, guiding athletes to sleep more before training with more intense loads is recommended.

Objective: The aim of this study was to assess the effects of resistance exercise and stretching on sleep, mood, and quality of life in chronic insomnia patients. Methods: Three 4-month treatments included: resistance exercise (n=10), stretching (n=10), and control (n=8). Sleep was evaluated with polysomnography, actigraphy, and questionnaires. Mood and quality of life were assessed with the Profile of Mood States (POMS) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), respectively. Results: There were no significant treatment differences between resistance exercise and stretching. However, compared with the control treatment, resistance exercise and stretching led to significantly greater improvements in Insomnia Severity Index scores (-10.5±2.3, -8.1±2.0 vs. 2.3±1.8, respectively), and actigraphic measures of sleep latency (-7.1±4.6, -5.2±1.9 vs. 2.2±2.1 min), wake after sleep onset (-9.3±2.8, -7.1±3.0 vs. 3.6±4.2 min), and sleep efficiency (4.4±1.8, 5.0±0.8 vs. -2.3±2%). Pittsburgh Sleep Quality Index (PSQI) global scores (-5.3±0.8, -3.9±1.5 vs. -0.1±0.8) and sleep duration (1.2±0.3, 1.6±0.6 vs. -0.1±0.2 h) also improved following both experimental treatments compared with control. PSQI-Sleep efficiency increased after resistance exercise compared with control (19.5±3.9 vs. 2.1±4.3%). No significant differences were observed in polysomnography or quality of life measures. Tension-anxiety was lower in the stretching group than the control group. Conclusion: Moderate-intensity resistance exercise and stretching led to similar improvements in objective and subjective sleep in patients with chronic insomnia. Clinical trial registration: NCT01571115

Objective: To assess the interaction of chronotype with anxiety in patients with chronic primary insomnia. Methods: Sixty-four patients (50 women) with mean age 43.9±8.1 years were investigated with the Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) and State-Trait Anxiety Inventory (STAI). Results: Significant negative correlations of chronotype-MEQ score with STAI state-anxiety (r = -0.40, p < 0.05), STAI trait-anxiety (r = -0.40, p < 0.05), and STAI pre-sleep state anxiety (r = -0.30, p < 0.05) were observed. Eveningness preference was associated with higher trait, state, and pre-sleep state anxiety. Conclusions: These results suggest that chronotype may be an important parameter to identifying the origin and significance of a vicious anxiety-insomnia-depression cycle in patients with chronic primary insomnia.

Objective: To evaluate the effects of 20 weeks of resistance and concurrent training on psychotic and depressive symptoms, quality of life outcomes, and serum IGF-1, IGFBP-3, and brain-derived neurotrophic factor (BDNF) concentrations in patients with schizophrenia. Methods: In this blind, randomized controlled clinical trial, 34 patients with schizophrenia were assigned to one of three groups: control (CTRL, n=13), resistance exercise (RESEX, n=12), or concurrent exercise (CONCEX, n=9). Symptoms, quality of life, strength, and other variables were assessed. Results: A significant time-by-group interaction was found for the RESEX and CONCEX groups on the Positive and Negative Syndrome Scale (PANSS) total score for disease symptoms (p = 0.007), positive symptoms (p = 0.003), and on the arm extension one-repetition maximum (1RM) test (p = 0.016). In addition, significant improvements on negative symptoms (p = 0.027), on the role-physical domain of the Short Form-36 Health Survey (p = 0.019), and on the chest press 1RM test (p = 0.040) were observed in the RESEX group. No changes were observed for the other variables investigated. Conclusions: In this sample of patients with schizophrenia, 20 weeks of resistance or concurrent exercise program improved disease symptoms, strength, and quality of life. ClinicalTrials.gov: NCT01674543.

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA).METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed.RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143).CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

O futebol de amputados é uma variação do futebol convencional, onde participam atletas amputados de membros inferiores e membros superiores (goleiro). O objetivo do estudo foi investigar as características físicas e antropométricas de atletas de futebol para amputados e verificar se existem diferenças entre a frequência cardíaca de pico (FCpico) e equações de predição da frequência cardíaca máxima (FCmax). Doze jogadores de futebol para amputados da seleção brasileira participaram do estudo. Foi mensurada a massa corporal, estatura e composição corporal. Os testes físicos utilizados foram: corrida de 20 m, teste do quadrado e o Yo Yo intermitent recovery test - level 1 (YYIRT1). O percentual de gordura foi significativamente diferente entre os meio-campistas e defensores. Não foram encontradas diferenças significativas entre as posições nos testes físicos. A FCpico foi significativamente menor do que todas as equações de predição da FCmax testadas. Conclui-se que os indicadores de desempenho físico não diferenciaram significativamente entre as diferentes funções táticas dos jogadores, e que a resposta cardíaca após esforço máximo intermitente é menor quando comparada com as equações de predição da FCmax investigadas.

Amputee football is a variation of conventional soccer in which athletes with lower limb amputation and one athelete with upper limb amputation (the goalkeeper) participate. The objective of this study was to investigate the anthropometric and physical characteristics of amputee football athletes and to verify differences between heart rate peak (HRpeak) and equations for predicting maximum heart rate (HRmax). Twelve amputee soccer players from the Brazilian team participated in this study. The body mass, height and body composition were measured. The physical tests used were: the 20 m running test, the T-square test and the Yo Yo intermitent recovery test - level 1 (YYIRT1). The percentage of fat was significantly different between midfielders and defenders. No significant differences were found between positions in the physical tests. The HRpeak was significantly lower than all of HRmax prediction equations tested. We conclude that the indicators of physical performance did not differ significantly between the different tactics roles of players, and that, after intermittent maximum effort, the cardiac response was lower when compared with the investigated HRmax prediction equations.

El fútbol de amputados es una variante del fútbol convencional, en el cual participan atletas amputados de miembros inferiores y miembros superiores (portero). El objetivo del estudio fue investigar las características físicas y antropométricas de atletas de fútbol para amputados y verificar si hay diferencias entre frecuencia cardíaca pico (FCpico) y ecuaciones de predicción de frecuencia cardíaca máxima (FCmax). Doce jugadores de fútbol para amputados del equipo oficial brasileño participaron del estudio. Fue mensurada la masa corporal, estatura y composición corporal. Los testes físicos utilizados fueron: carrera de 20 m, test del cuadrado y Yo Yo intermitent recovery test - level 1 (YYIRT1). El porcentual de grasa fue significativamente diferente entre los mediocampistas y defensores. No fueron identificadas diferencias significativas entre las posiciones en los testes físicos. FCpico fue significativamente menor que todas las ecuaciones de predicción de FCmax evaluadas. Concluí-se que los indicadores de desempeño físico no diferenciaron significativamente entre las diferentes funciones tácticas de los jugadores y que la respuesta cardíaca tras el esfuerzo máximo intermitente es menor si comparadas con las ecuaciones de predicción de FCmax investigados.

OBJETIVO: Avaliar a densidade mineral óssea (DMO) e relacioná-la com a ingestão alimentar e composição corporal de adolescentes modelos de passarela. MÉTODOS: Estudo transversal avaliando 33 modelos e 33 não modelos de 15 a 18 anos pareadas por idade e índice de massa corporal (IMC). A densidade mineral óssea da coluna (L1-L4) foi avaliada por meio da técnica da absorciometria de feixe duplo de energia (Lunar® DPX Alpha), e a composição corporal, pela técnica de pletismografia. A ingestão alimentar foi avaliada por meio do registro alimentar de 3 dias. RESULTADOS: A média de idade das adolescentes foi de 16,75±1,04 anos, sendo que 24% apresentaram IMC abaixo dos valores ideais para a idade. Não houve diferença de DMO entre modelos (1,108±0,080 g/cm2) e não modelos (1,096±0,102 g/cm2) (p > 0,05), sendo identificada uma porcentagem de 6% de baixa DMO para a idade. Observou-se que a média de ingestão de energia foi menor entre as modelos em comparação às adolescentes não modelos (1.480,93±582,95 versus 1.973,00±557,63 kcal) (p > 0,05) e que a maioria das adolescentes de ambos os grupos apresentou consumo inadequado de micronutrientes, ressaltando-se a baixa ingestão de cálcio. Verificou-se correlação significativa da DMO apenas com a massa magra (kg) (modelos r = 0,362 e não modelos r = 0,618; p < 0,05). CONCLUSÃO: Apesar de não ter sido encontrada associação entre a DMO, o IMC e a ingestão de nutrientes importantes no processo de mineralização óssea, as inadequações na ingestão alimentar podem influenciar negativamente a aquisição de massa óssea, que se encontra potencializada neste estágio de vida.

OBJECTIVE: To evaluate the bone mineral density (BMD) and to relate it to the food intake and body composition of adolescent runway models. METHODS: Cross-sectional study evaluating 33 models and 33 non-models aged from 15 to 18 years, paired by age and body mass index (BMI). BMD of spine (L1-L4) was evaluated using the dual-energy X-ray absorptiometry technique (Lunar® DPX Alpha), and body composition was assessed by means of plethysmography. Food intake was evaluated by a 3-day-food record. RESULTS: The subjects mean age was 16.75±1.04 years, and 24% had BMI below ideal value for their age. BMD values (g/cm2) were similar between models (1.108±0.080) and non-models (1.096±0.102) (p > 0.05), and 6% of the participants had low BMD for age. We found that the mean energy intake was lower among models as compared to non-models (1,480.93±582.95 vs. 1,973.00±557.63 kcal) (p < 0.05) and that most of the adolescents in both groups presented an inadequate consumption of micronutrients, with emphasis to the low calcium intakes. There was only significant correlation between BMD and lean body mass (kg) (r = 0.362 for models and r = 0.618 for non-models) (p < 0.05). CONCLUSION: Although no association was found between BMD, BMI, and intake of nutrients which are important for the bone mineralization process, inadequacies of food intake have an adverse influence on the acquisition of bone mass, which is more effective at this stage of life.

O sono ocupa cerca de um terço de nossas vidas, entretanto seu impacto na saúde e sua influência nas condições patológicas ainda não foi completamente elucidado. A prevalência dos distúrbios de sono é cada vez maior, sobretudo nas regiões mais industrializadas, repercutindo diretamente no bem-estar da população. Este artigo tem como objetivo sintetizar e atualizar a literatura a respeito do método de privação de sono paradoxal e seu panorama de conseqüências desde comportamentais até genéticas em animais. Ainda, destacamos a contribuição e relevância dos estudos experimentais realizados por nosso grupo nas ultimas três décadas.

Sleep comprises approximately one-third of a person's lifetime, but its impact on health and medical conditions remains partially unrecognized. The prevalence of sleep disorders is increasing in modern societies, with significant repercussions on people's well-being. This article reviews past and current literature on the paradoxical sleep deprivation method as well as data on its consequences to animals, ranging from behavioral changes to alterations in the gene expression. More specifically, we highlight relevant experimental studies and our group's contribution over the last three decades.

OBJETIVOS: Analisar a influência de obesidade na contagem de células imunológicas e na concentração dos hormônios cortisol e leptina, a fim de estabelecer uma relação entre as variáveis analisadas. MÉTODOS: Foram recrutados 27 adolescentes obesos [índice de massa corporal (IMC) ≥ percentil 95[ e 21 não-obesos (IMC ≤ percentil 75), de ambos os sexos, com idade entre 15 e 19 anos, na fase pós-púbere. O IMC foi calculado através da divisão do peso pela altura ao quadrado e a composição corporal foi estimada por pletismografia no sistema Bod PodTM. Amostras de sangue foram colhidas para análise de leucócitos, neutrófilos, linfócitos, monócitos, plaquetas, cortisol e leptina. O teste de Kolmogorov-Smirnov foi utilizado, seguido pelo teste t de Student independente supondo distribuição normal. O nível de significância estabelecido foi p < 0,05 e expresso como média ± desvio padrão. Os dados foram analisados utilizando o programa SPSS para Windows versão 12.0. RESULTADOS: Não houve diferença entre o grupo obeso e o não-obeso na concentração sérica de leucócitos, neutrófilos, linfócitos, monócitos e cortisol. O grupo de adolescentes obesos apresentou maiores concentrações de plaquetas e leptina (p < 0,01). A prevalência de hiperleptinemia foi de 25,92% nos adolescentes obesos (15,38%, sexo masculino e 35,7%, feminino). CONCLUSÕES: Os adolescentes obesos apresentaram maiores concentrações de plaquetas e leptina em comparação aos não-obesos. Observou-se que as adolescentes obesas apresentaram maior prevalência de hiperleptinemia do que os adolescentes obesos.

OBJECTIVE: To analyze the influence of obesity status on immune cell count and concentration of the hormones cortisol and leptin, in order to establish a relationship among the variables analyzed. METHODS: We recruited 27 obese [body mass index (BMI) ≥ 95th percentile[ and 21 non-obese (BMI ≤ 75th percentile) adolescent boys and girls, aged 15-19 years at the post-pubertal stage. BMI was calculated as body weight divided by height squared, and body composition was estimated by plethysmography in the Bod PodTM system. Blood samples were collected to analyze leukocytes, neutrophils, lymphocytes, monocytes, platelets, cortisol, and leptin. The Kolmogorov-Smirnov test was performed, followed by the independent Student t test in case of normal distribution. Significance values were set at p < 0.05 and expressed as means ± standard deviation. The statistical package SPSS for Windows version 12.0 was used. RESULTS: There was no difference between obese and non-obese adolescents in terms of leukocyte, neutrophil, lymphocyte, monocyte and cortisol serum concentrations. The group of obese adolescents presented higher platelet and leptin concentrations (p < 0.01). The prevalence of hyperleptinemia was 25.92% in the obese adolescents (15.38% in boys and 35.7% in girls). CONCLUSIONS: Obese adolescents have higher platelet and leptin concentrations in comparison with non-obese adolescents. It was also found that obese girls presented a higher prevalence of hyperleptinemia than obese boys.

O objetivo do presente estudo foi avaliar a influência da hora do dia nos parâmetros da cinética do consumo de oxigênio de ciclistas durante exercício muito intenso. Nove voluntários do sexo masculino realizaram exercícios de carga constante às 08:00, 13:00 e 18:00 h, em dias diferentes. Estes exercícios foram realizados duas vezes em cada visita, com um intervalo de 1 h entre eles. A intensidade usada foi de 75%Δ (75% da diferença entre o VO2 no limiar de lactato e o VO2max. A amplitude do componente primário do VO2 (2597 ± 273 ml.min-1, 2513 ± 268 ml.min-1 e 2609 ± 370 ml.min-1), a constante de tempo do componente primário do VO2 (19.3 ± 2.5 s, 18.4 ± 3.0 s e 19.7 ± 3.9 s), o componente lento do VO2 (735 ± 81 ml.min-1, 764 ± 99 ml.min-1 e 680 ± 121 ml.min-1) e o tempo de resposta média (51.8 ± 4.2 s, 51.2 ± 4.2 s e 51.4 ± 3.4 s) não apresentaram diferenças significativas entre os diferentes horários do dia (08:00, 13:00 e 18:00 h), assim como os demais parâmetros da cinética do VO2. Estes resultados sugerem que a resposta da cinética do VO2 de ciclistas durante exercício muito intenso (75%Δ) não é influenciada pela hora do dia.

The objective of the present study was to evaluate the influence of the time of day on the parameters of oxygen uptake kinetics of trained cyclists during high intensity exercise. Nine male volunteers repeated bouts at constant loads at 08:00, 13:00 and 18:00 h on different days. These exercise bouts were performed twice on each occasion, with an interval of 1 h between them. The load intensity used was 75%Δ (75% of the difference between the VO2 at the lactate threshold and the VO2max). The primary VO2 amplitude (2597 ± 273 ml.min-1, 2513 ± 268 ml.min-1 and 2609 ± 370 ml.min-1), the primary VO2 time constant (19.3 ± 2.5 s, 18.4 ± 3.0 s and 19.7 ± 3.9 s), the VO2 slow component (735 ± 81 ml.min-1, 764 ± 99 ml.min-1 and 680 ± 121 ml.min-1) and the mean response time (51.8 ± 4.2 s, 51.2 ± 4.2 s and 51.4 ± 3.4 s) did not present significant differences at the different times (08:00, 13:00 and 18:00 h), neither did the other parameters of the VO2 kinetics. These results suggest that the response of the VO2 kinetics of cyclists exercising at high intensity (75%Δ) is not influenced by the time of day.

O objetivo do presente estudo foi comparar, em domínio muito intenso de exercício, diferentes técnicas utilizadas para medir a amplitude do componente lento (CL) da cinética do consumo de oxigênio. Dez ciclistas treinados, do gênero masculino [média ± DP (idade: 25 ± 3,6 anos, massa corporal: 67,2 ± 4,5kg, altura: 174,8 ± 6,5cm e VO2max: 62,4 ± 3,1ml.kg¹.min¹)], realizaram duas idênticas transições de carga constante (intensidade de 75%delta: 75% da diferença entre o VO2 no limiar de lactato e o VO2max) em dias diferentes. O CL foi calculado a partir de diferentes métodos: (1) modelo biexponencial [VO2(t) = VO2base + A1 (1 e-(t-TA1/t1)) + A2 (1 e(tTA2/t2))], (2) intervalos predeterminados (o deltaVO26-2: diferença do VO2 entre o segundo e o sexto minuto de exercício e o deltaVO263: diferença do VO2 entre o terceiro e o sexto minuto de exercício) e (3) diferença entre o VO2 obtido no final do exercício e o valor obtido a partir de um ajuste monoexponencial do "componente primário" (tempo predeterminado de 120s) (CL6"CP"). Todos os métodos foram comparados entre si. Os resultados demonstraram significante subestimação do CL obtido pelo método de intervalos predeterminados (deltaVO26-2: 432 ± 126ml.min¹ e deltaVO263: 279 ± 88ml.min¹) quando comparado com o modelo biexponencial (676 ± 136ml.min¹) e ao CL6"CP" [(719 ± 265ml.min¹ (p < 0,05)]. Não houve diferenças significativas entre as outras comparações. Os resultados sugerem que a utilização de tempos predeterminados pode subestimar o CL quando comparado com o modelo biexponencial e com o CL6"CP".

The objective of the present study was to compare in severe exercise domain, different techniques used for measuring the amplitude of the slow component (SC) of oxygen uptake kinetics. Ten trained cyclists, male (age: 25 ± 3.6 years, body mass: 67.2 ± 4.5 kg, height: 174.8 ± 6.5 cm and VO2max: 62.4 ± 3.1 mL.kg¹.min¹), performed two identical bouts transitions at constant load [mean ± SD (intensity 75%delta: 75% of the difference between the VO2 lactate threshold and the VO2max)] in different days. The SC was calculated from different methods: (1) bi-exponential model [VO2(t) = VO2base + A1 (1 e(tTA1/t1)) + A2 (1 e(tTA2/t2))], (2) predetermined intervals (deltaVO262: difference between the second min VO2 and the end VO2; deltaVO263: difference between the third min VO2 and the end VO2) and (3) difference between the end VO2 and the value obtained from a mono-exponential adjustment of the "primary component" (predetermined time of 120 s) (SC6"PC"). All the methods were compared among themselves. The results showed a significant underestimation of the SC obtained by method of predetermined intervals (deltaVO262: 432 ± 126 ml.min¹ and deltaVO26-3: 279 ± 88 ml.min-1) when compared with bi-exponential model (676 ± 136 ml.min-1) and SC6-"PC" [(719 ± 265 ml.min-1 (p < 0.05)]. There was not significant difference among the other comparison. The results suggest that the use of predetermined time may underestimate the SC when compared with bi-exponential model and SC6"PC".

O objetivo do presente estudo foi avaliar as alterações promovidas, por intervenção multidisciplinar, nas concentrações plasmáticas de grelina e leptina, adiposidade visceral e prevalência de esteatose hepática não alcoólica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m²) e 12 meninos (IMC 37,08 ± 3,17kg/m²), com idade entre 15 e 19 anos, quanto à concentração de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnóstico de NAFLD pelo método de ultra-sonografia. Os resultados demonstraram redução significante na concentração circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda redução percentual na prevalência de NAFLD, sendo este um resultado relevante, visto que esta doença pode progredir para cirrose, tanto em crianças quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabólico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

The aim of this study was to assess the changes promoted by a multidisciplinary therapy in ghrelin and leptin concentrations, visceral adiposity and non-alcoholic fat liver disease-NAFLD, in obese adolescents. A total of 28 obese adolescents, 16 girls (BMI 34.58 ± 3,86 wt/ht²) and 12 boys (BMI 37.08 ± 3.17 wt/ht²), aged between 15 and 19 years old, was evaluated to leptin, ghrelin and insulin concentrations, visceral adiposity and NAFLD through ultrasonography. The results showed a significant decrease in ghrelin, leptin concentrations and visceral adiposity (p < 0.01). Moreover, a decrease in the NAFLD prevalence was observed. It is an important result, since this disease can progress to cirrhosis, not only in children but also in obese adolescents. This kind of treatment can be efficient to improve metabolic and hormonal profile, as well as, to control obesity and related co-morbidities in obese adolescents.

El objetivo del presente trabajo ha sido evaluar las alteraciones promovidas por la intervención multidisciplinar, en las concentra- ciones plasmáticas de grelina y leptina, adiposidad visceral y prevalencia de esteatosis hepática no alcohólica - NAFLD, en adolescentes obesos. 28 adolescentes obesos, 16 chicas (IMC 34,58 ± 3,86 kg/m²) y 12 chicos (IMC 37,08 ± 3,17 kg/m²), con edades entre 15 y 19 años, fueron evaluados respecto a la concentración de leptina, grelina, insulina, así como a la adiposidad visceral y el diagnóstico de NAFLD por el método de ultrasonografía. Los resultados demostraron una reducción significante en la concentra- ción circulante de grelina y leptina y en la adiposidad visceral (p < 0,01). Hubo aún una reducción porcentual en la prevalencia de NAFLD, siendo este un resultado relevante, ya que esta enfermedad puede progresar hasta la cirrosis, tanto en niños como en adolescentes obesos. Este tipo de tratamiento demostró ser eficiente en la mejora del perfil metabólico y hormonal, contribuyendo para el control de la obesidad y su comorbilidad en adolescentes obesos.