Marcio Mancini | Universidade de São Paulo (original) (raw)

Papers by Marcio Mancini

Arquivos brasileiros de endocrinologia e metabologia

Sao Paulo Medical Journal, 1994

Arquivos Brasileiros de Endocrinologia & Metabologia, 2014

Brown adipose tissue, an essential organ for thermoregulation in small and hibernating mammals du... more Brown adipose tissue, an essential organ for thermoregulation in small and hibernating mammals due to its mitochondrial uncoupling capacity, was until recently considered to be present in humans only in newborns. The identification of brown adipose tissue in adult humans since the development and use of positron emission tomography marked with 18-fluorodeoxyglucose (PET-FDG) has raised a series of doubts and questions about its real importance in our metabolism. In this review, we will discuss what we have learnt since its identification in humans as well as both new and old concepts, some of which have been marginalized for decades, such as diet-induced thermogenesis. Arq Bras Endocrinol Metab. 2014;58(9):889-99

The efficacy and tolerability of the association of sibutramine (10mg) and orlistat (120mg t.i.d.... more The efficacy and tolerability of the association of sibutramine (10mg) and orlistat (120mg t.i.d.) in the treatment of obesity were evaluated in a 3- month short-term open study. The study involved 114 overweight or obese non-diabetic patients searching for obesity treatment in a private clinic. After two months, the mean weight loss was 7.1kg (- 6.5%) and after three months,

Arquivos Brasileiros De Endocrinologia E Metabologia, 2000

Obesity is a disease with high prevalence and obese individuals have a higher risk of cardiovascu... more Obesity is a disease with high prevalence and obese individuals have a higher risk of cardiovascular diseases, diabetes mellitus, dyslipidemia and Obstructive Sleep Apnea Syndrome (OSAS). OSAS is a chronic, pro- gressive, incapacitating disease with high cardiovascular mortality and morbidity. Clinical symptoms include snoring, respiratory pauses, agita- ted sleep, nocturia, sudoresis, excessive sleepiness, headache in the morning, neurocognitive deficits, personality

International Journal of Obesity, 2009

Objective:To evaluate the efficacy of diethylpropion on a long-term basis, with emphasis in cardi... more Objective:To evaluate the efficacy of diethylpropion on a long-term basis, with emphasis in cardiovascular and psychiatric safety aspects.Design:Randomized, double-blind, placebo-controlled trialMeasurements:Following a 2-week screening period, 69 obese healthy adults received a hypocaloric diet and were randomized to diethylpropion 50 mg BID (n=37) or placebo (n=32) for 6 months. After this period, all participants received diethylpropion in an open-label extension for

Journal of Obesity, 2010

Objective. To assess the efficacy and tolerability of the association sibutramine (10-20 mg/day) ... more Objective. To assess the efficacy and tolerability of the association sibutramine (10-20 mg/day) and orlistat (120 mg 2-3 times a day) in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (−9.8% of the initial weight, n = 263), and after 6 months, the mean weight loss was 13.9 kg (−12.8% of the initial weight, n = 97). The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately.

Jornal Vascular Brasileiro, 2010

To present the components of the metabolic syndrome in children and adolescents and to discuss ho... more To present the components of the metabolic syndrome in children and adolescents and to discuss how they are assessed in the pediatric population in addition to presenting the major metabolic syndrome classifications for the age group.

The Journal of Clinical Endocrinology & Metabolism, 2014

The mechanisms by which obesity alters the cerebral function and the effect of weight loss on the... more The mechanisms by which obesity alters the cerebral function and the effect of weight loss on the brain have not been completely clarified.

Treatments in Endocrinology, 2005

Weight reduction has been shown to improve glycemic control and cardiovascular risk factors assoc... more Weight reduction has been shown to improve glycemic control and cardiovascular risk factors associated with insulin resistance in obese individuals with type 2 diabetes mellitus. Therapeutic options for these patients include promoting weight loss (non-pharmacologic and pharmacologic treatment) and improving glycemic control, as well as treating common associated risk factors such as arterial hypertension and dyslipidemias. This article provides an overview of anti-obesity drugs used in the treatment of obese individuals with type 2 diabetes. The most widely investigated drugs, sibutramine and orlistat, result in modest, clinically worthwhile weight loss, with demonstrable improvements in many co-morbidities, among them, type 2 diabetes. Clinical trials with these anti-obesity medications in cohorts of obese diabetic patients have been reviewed as well as cathecolaminergic agents (diethylpropion [amfepramone], fenproporex, mazindol, ephedrine-caffeine combination), serotoninergic drugs (fenfluramine, dexfenfluramine, fluoxetine), and other drugs that have some action on weight loss (the antidiabetic agent metformin, anti-epileptic agents topiramate and zonisamide, and the antidepressive bupropion [amfebutamone]). These trials show variable benefits in terms of effects on glucose profiles.

Surgery for Obesity and Related Diseases, 2010

Background: An audit performed in the use of non-irradiated femoral head bone graft at the Geelon... more Background: An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the nonirradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission. Methods: We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient's medical record. All complications, including infections, related to the use of the allograft were recorded. Results: We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded. Conclusion: The use of non-irradiated femoral head bone graft was safe in a regional setting.

Pharmaceuticals, 2010

Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, ... more Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, however, currently offers disappointing results, with very high rates of weight loss failure or weight regain cycles, and only two drugs (orlistat and sibutramine) approved for long-term use. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. Our review focuses on the rationale for their use, with advantages and disadvantages; on combinations often used, with or without studies; and on new perspectives of combinations being studied mainly by the pharmaceutical industry.

Obesity Surgery, 2010

Background Weight loss and nutritional status 5 or more years after Roux-en-Y gastric bypass was ... more Background Weight loss and nutritional status 5 or more years after Roux-en-Y gastric bypass was prospectively documented. The hypothesis was that even after clinical adaptation, imbalances might still occur. Methods Seventy-five consecutive patients (age 49.3± 10.6 years, 89.3% females) were recruited 83.4 ± 14.3 months after the intervention. Weight loss and nutritional abnormalities were registered. Results Body mass index (BMI) was 56.5±10.0 preoperatively, 29.4±6. 2 by 24 months and 34.4±14.6 when last seen. Major current deficit occurred for magnesium (32.1% of the patients), hemoglobin (50.8%), iron (29.8%), ferritin (36.0%), zinc (40.5%), vitamin B 12 (61.8%), vitamin D 3 (60.5%), and β-carotene (56.8%). Low preoperative measurements had already been unveiled for iron, transferrin, zinc, and vitamin B 12 . Total drug consumption tended to decrease after operation, and present findings correlated with excess weight loss (EWL). Also presence of diabetes and BMI value were predictors of long-term EWL, along with biochemical profile by 2 years. Multivitamin supplementation and gastrointestinal complaints partially correlated with nutritional results. Conclusions (1) Good initial weight loss with moderate late regain, anemia, and multiple nutrient deficits was the common pattern. (2) Massive weight loss, frequent vomiting, dumping syndrome, and women in reproductive age were risk factors for hemoglobin or vitamin deficits, whereas superobesity, diabetes, and use of multiple drugs were associated with EWL result. (3) Most laboratory tests became stable by 2 years and along with BMI correlated with late EWL. (4) Two-year nutritional investigation is especially recommended because of its long-term predictive value.

Obesity Surgery, 2005

There are many studies concerning thyroid function in obesity, and some of them describe higher T... more There are many studies concerning thyroid function in obesity, and some of them describe higher TSH levels in obese subjects. Few studies evaluated long-term changes in thyroid function caused by weight loss after bariatric surgery. Our aims were to evaluate the prevalence of subclinical hypothyroidism (SH) in a morbidly obese population and to analyze the effect of weight loss induced by Roux-en-Y gastric bypass (RYGBP) on TSH and thyroid hormone (TH) levels. TSH, free thyroxine (fT4) and total triiodothyronine (T3) levels were analyzed before and 12 months after RYGBP in patients with grade III or grade II obesity with co-morbidities. Subjects taking TH and/or with positive antithyroid antibodies and/or with overt hypothyroidism were excluded. 72 subjects (62F/10M), with mean age 39.6+/-9.8 years and mean BMI 53.0+/-10.4 kg/m2 were studied. The prevalence of SH before RYGBP was 25% (n=18). There was a significant post-surgical decrease in BMI in the whole population, as well as in SH patients. In the SH group and normal TSH group, there was a decrease in TSH and T3, but not in fT4. TSH was not correlated with initial BMI or percent change in BMI. TSH concentrations reached normal values in all SH patients after RYGBP. Our data confirm that severe obesity is associated with increased TSH. The decrease in TSH was independent of BMI, but occurred in all SH patients. A putative effect of weight reduction on the improvement of SH in all patients may be an additional benefit of bariatric surgery.

Obesity Surgery, 2011

Background: The purpose of this study was to evaluate the effect of the duodenal-jejunal bypass l... more Background: The purpose of this study was to evaluate the effect of the duodenal-jejunal bypass liner (DJBL), a 60-cm, impermeable fluoropolymer liner anchored in the duodenum to create a duodenal-jejunal bypass, on metabolic parameters in obese subjects with type 2 diabetes. Methods: Twenty-two subjects (mean age, 46.2 -10.5 years) with type 2 diabetes and a body mass index between 40 and 60 kg/m 2 (mean body mass index, 44.8 -7.4 kg/m 2 ) were enrolled in this 52-week, prospective, openlabel clinical trial. Endoscopic device implantation was performed with the patient under general anesthesia, and the subjects were examined periodically during the next 52 weeks. Primary end points included changes in fasting blood glucose and insulin levels and changes in hemoglobin A1c (HbA1c). The DJBL was removed endoscopically at the end of the study. Results: Thirteen subjects completed the 52-week study, and the mean duration of the implant period for all subjects was 41.9 -3.2 weeks. Reasons for early removal of the device included device migration (n = 3), gastrointestinal bleeding (n = 1), abdominal pain (n = 2), principal investigator request (n = 2), and discovery of an unrelated malignancy (n = 1). Using last observation carried forward, statistically significant reductions in fasting blood glucose ( -30.3 -10.2 mg/dL), fasting insulin ( -7.3 -2.6 lU/mL), and HbA1c ( -2.1 -0.3%) were observed. At the end of the study, 16 of the 22 subjects had an HbA1c < 7% compared with only one of 22 at baseline. Upper abdominal pain (n = 11), back pain (n = 5), nausea (n = 7), and vomiting (n = 7) were the most common device-related adverse events. Conclusions: The DJBL improves glycemic status in obese subjects with diabetes and therefore represents a nonsurgical, reversible alternative to bariatric surgery.

Obesity Reviews, 2003

The information presented in this article provides an overview of physiological agents, therapeut... more The information presented in this article provides an overview of physiological agents, therapeutics in current use, and medications that have been extensively used in the past but are no longer available, or are not classically considered as anti-obesity drugs. The authors present an extensive review on the criteria for anti-obesity management efficacy, on physiological mechanisms that regulate central and/or peripheral action energetic homeostasis (nutrients, monoamines and peptides), and on b -phenethylamine pharmacological-derivative agents (fenfluramine, dexfenfluramine, phentermine, diethylpropion, fenproporex and sibutramine), tricyclic derivatives (mazindol), phenylpropanolamine derivatives (ephedrine, phenylpropanolamine), a phenylpropanolamine oxy-tri-fluor-phenyl derivative (fluoxetine), a naftilamine derivative (sertraline) and a lipstatine derivative (orlistat). An analysis of all clinical trials longer than 10 weeks in duration is also presented for medications used in the management of obesity.

Obesity Reviews, 2008

Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea... more Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. Obesity affects upper airway anatomy because of fat deposition and metabolic activity of adipose tissue. Obstructive sleep apnea-hypopnea syndrome and metabolic syndrome have several characteristics such as visceral obesity, hypertension and insulin resistance. Inflammatory cytokines might be related to the pathogenesis of sleep apnea and metabolic syndrome. Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.

Obesity, 2006

MANCINI, MARCIO C., ANA P.A.C. COSTA, MARIA EDNA DE MELO, CINTIA CERCATO, DANIEL GIANNELLA-NETO, ... more MANCINI, MARCIO C., ANA P.A.C. COSTA, MARIA EDNA DE MELO, CINTIA CERCATO, DANIEL GIANNELLA-NETO, ARTHUR B. GARRIDO, JR., STEN ROSBERG, KERSTIN ALBERTSSON-WIKLAND, SANDRA M.F. VILLARES, AND ALFREDO HALPERN. Effect of gastric bypass on spontaneous growth hormone and ghrelin release profiles. Obesity. 2006;14:383-387.