Aims/hypothesis The aim was to conduct a systematic review and meta-analysis of randomised controlled clinical trials assessing the effect of probiotic, prebiotic or synbiotic supplementation on gut microbiota and glucose control and lipid levels in individuals with diabetes. Methods MEDLINE, EMBASE and the Cochrane Library were searched. The eligibility criteria for the studies was involvement of participants with a diagnosis of type 1 or type 2 diabetes. Metabolic outcomes (glucose control, insulinaemia, and lipid profile) of any probiotic, prebiotic or synbiotic supplementation related to modification of gut microbiota (prebiotics, probiotics and synbiotics) were analysed. We provided a narrative synthesis and meta-analysis of the findings on metabolic outcomes from the studies. Metabolic outcomes were extracted post-intervention and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. We pooled the results using a random-effects meta-analysis. The meta-analysis was conducted using Review Manager (RevMan) software. Results After the removal of duplicates and ineligible studies, 5219 studies were retained for review of titles and abstracts. The number of articles was reduced to 130 by review, for which the full-text articles were obtained and reassessed, 38 of which were included in the final meta-analysis. Overall, the use of prebiotics, probiotics or synbiotics reduced HbA 1c levels, but did not reach the threshold for significance (−2.17 mmol/mol, 95% CI −4.37, 0.03; p = 0.05, [−0.20%, 95% CI −0.40 to 0.00; p = 0.05, I 2 = 66%]) and had no effect on LDL-cholesterol levels (−0.05 mmol/l; 95% CI −0.14, 0.05, p = 0.35, I 2 = 37%). However, their consumption decreased levels of fasting blood glucose (−0.58 mmol/l; 95% CI −0.86, −0.30; p < 0.01, I 2 = 60%), total cholesterol (−0.14 mmol/l; 95% CI −0.26, −0.02, p = 0.02, I 2 = 39%), triacylglycerols (−0.11 mmol/l; 95% CI −0.20, −0.02, p = 0.01, I 2 = 21%) and insulinaemia (−10.51 pmol/l; 95% CI −16.68,−4.33, p < 0.01, I 2 = 74%), and increased HDL-cholesterol levels (0.04 mmol/l; 95% CI 0.01, 0.07, p < 0.01, I 2 = 24%).

Purpose There are no criteria to establish priority for bariatric surgery candidates in the public health system in several countries. The aim of this study is to identify preoperative characteristics that allow predicting the success after bariatric surgery. Materials and Methods Four hundred and sixty-one patients submitted to Roux-en-Y gastric bypass were included. Success of the surgery was defined as the sum of five outcome variables, assessed at baseline and 12 months after the surgery: excess weight loss, use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) as a treatment for obstructive sleep apnea (OSA), daily number of antidiabetics, daily number of antihypertensive drugs, and all-cause mortality. Partial least squares (PLS) regression and multiple linear regression were performed to identify preoperative predictors. We performed a 90/10 split of the dataset in train and test sets and ran a leave-one-out cross-validation on the train set and the best PLS model was chosen based on goodness-of-fit criteria. Results The preoperative predictors of success after bariatric surgery included lower age, presence of non-alcoholic fatty liver disease and OSA, more years of CPAP/BiPAP use, negative history of cardiovascular disease, and lower number of antihypertensive drugs. The PLS model displayed a mean absolute percent error of 0.1121 in the test portion of the dataset, leading to accurate predictions of postoperative outcomes. Conclusion This success index allows prioritizing patients with the best indication for the procedure and could be incorporated in the public health system as a support tool in the decision-making process. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-020-05103-0.

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Purpose: Myopia has been considered a public health issue by the World Health Organization since 2015.The growing incidence of myopia worldwide, called the myopia epidemic, and its potential blinding complications in adulthood like cataract, glaucoma, retinal detachment and maculopathy, have been extensively published and discussed in peer review papers. Nonetheless, little information about Latin America is available. This study aims to detect the prevalence of myopia in southern Brazil, the biggest country of South America. Methods: A prospective cross sectional study recruited 330 public school children between 2019 and 2021, aged 5 to 20 years old. All children underwent a comprehensive eye examination and detailed lifestyle questionnaire. The Pearson correlation coefficient, Kruskal Wallys and the Chi-Square Test were used to assess simple correlations and associations between myopia and medical conditions, use of medications, ophthalmic history and family history of ocular conditions, besides demographics and lifestyle focused on screen time/day. Associations between the results of the ophthalmologic evaluation and all factors included in the questionnaire were analyzed using the Generalized Estimating Equation model (GEE). The prevalence of hyperopia and astigmatism were also assessed. Results: Total prevalence of myopia was 17.4% (CI 13.8 – 21.7%). Low myopia (-0.50D to -5.75D) comprised 15.2% (CI 11.9 – 19.3%) and high myopia (-6,00D or worse) was 2.1% (CI 1.1 – 4.1%). Relative risk of myopia for females was 1.6 (CI 1.00 – 2.57%) and each additional hour of screen time increased a child’s chance of having myopia by 6.5%. The prevalence of hyperopia was 7,7% (CI 5.4 -10.9%) and of astigmatism, either myopic or hyperopic, was 25.6% (CI 21.4 – 30.2%). Conclusions: Brazil has always been considered a hyperopic country. These are the highest reported prevalences of myopia under cycloplegia and the first paper to present myopia as a more prevalent refractive error than hyperopia among Brazilian school children to date.

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Aims To evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis. Methods A systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence. Results We included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66–39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil. Conclusion This review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed—expected in systematic reviews of prevalence—raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.